Do Measures of Heart Rate Variability Predict Injury Severity in Trauma Victims?

Richard D. Zane, MD, FAAEM 

A sophisticated measure of decreased heart rate variability was associated with need for resuscitative procedures.

Heart rate variability (HRV) has been described as a “new vital sign” and is theorized to relate to severe illness and increased mortality in trauma victims, even before traditional vital sign disturbance occurs; however, the inability to measure HRV in real time has limited its adoption in clinical practice, so researchers developed a miniaturized device that analyzes electrocardiography output in real time to instantaneously determine HRV and heart rate complexity (HRC, the degree of variation in R–R intervals over a series of sampled time intervals). They prospectively assessed the predictive value of HRV and HRC in 82 adults who presented to a single level I trauma center and met criteria for trauma team activation.

Decreased HRC was an independent predictor of the need for a resuscitative intervention within 24 hours of admission. Interventions included transfusion, thoracostomy, cardiopulmonary resuscitation, endotracheal intubation, laparotomy, thoracotomy, angioembolization, needle chest decompression, vasoactive medication, and hyperosmolar fluid therapy. Patients who received a resuscitative intervention also had higher heart rate (mean, 94 vs. 82) and lower Glasgow Coma Scale score at presentation (mean, 9.4 vs. 14.9).

Citation(s):

Mejaddam AY et al. Real-time heart rate entropy predicts the need for lifesaving interventions in trauma activation patients. J Trauma Acute Care Surg 2013 Oct; 75:607.