Combat Casualties Undergoing Lifesaving Interventions Have Decreased Heart Rate Complexity at Multiple Time Scales

Abstract

We found that heart rate (HR) complexity metrics such as sample entropy (SampEn) identified patients with trauma receiving lifesaving interventions (LSIs). We now aimed (1) to test a multiscale entropy (MSE) index, (2) to compare it to single scale measures including SampEn, and (3) to assess different parameter values for calculation of SampEn and MSE. This was a study of combat casualties in an emergency department in Iraq. Electrocardiograms of 70 acutely injured adults were recorded. Twelve underwent LSIs and 58 did not. Lifesaving interventions included endotracheal intubation (9), tube thoracostomy (9), and emergency transfusion (4). From each electrocardiogram, a segment of 800 consecutive beats was selected. Offline, R waves were detected and R to R interval time series were generated. Sample entropy, MSE, and time domain measures of HR variability (mean HR, SD, the proportion of pairs of consecutive NN intervals that differ by more than 20 and 50 milliseconds, square root of the mean of the squares of differences between adjacent NN intervals) were computed. Differences in mean HR (LSI: 111 + or - 33, non LSI: 90 + or - 17 beats/min) were not significant. Systolicarterial pressure was statistically but not clinically different (LSI: 123 + or - 19, non LSI: 135 + or - 19 mm Hg). Sample entropy (LSI: 0.90 + or - 0.42, non LSI: 1.19 + or - 0.35; P less than .05) and MSE index (LSI: 2.58 + or - 2.55, non LSI: 5.67 + or - 2.48; P less than .001) differed significantly. Complexity of HR dynamics over a range of time scales was lower in high risk than in low risk combat casualties and outperformed traditional vital signs.

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Document Details

Document Type
Technical Report
Publication Date
Jan 01, 2013
Accession Number
ADA615013

Entities

People

  • Andriy I Batchinsky
  • Ary L. Goldberger
  • Corina Necsoiu
  • Josè Salinas
  • Leopoldo C. Cancio
  • Madalena D. Costa
  • William L. Baker

Organizations

  • United States Army Institute of Surgical Research

Tags

DTIC Thesaurus Topics

  • Cardiovascular Physiological Phenomena
  • Cardiovascular System
  • Casualties
  • Combat Casualty Care
  • Combat Injuries
  • Data Sets
  • Electrocardiography
  • Health Services
  • Heart Rate
  • Hemorrhage
  • Hemorrhagic Shock
  • Intervention
  • Medical Personnel
  • Patient Care
  • Statistical Analysis
  • Therapy
  • Vital Signs

Readers

  • Cardiovascular Physiology
  • Regression Analysis.
  • Trauma or Military Medicine