A comparison of central venous and arterial base deficit as a predictor of survival in acute trauma

• Published in: The American journal of emergency medicine Vol. 26; no. 2; pp. 119 - 123
• Main Authors: Schmelzer, Thomas M., MD, Perron, Andrew D., MD, Thomason, Michael H., MD, Sing, Ronald F., DO
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-02-2008; Elsevier; Elsevier Limited
• Subjects: Acid-Base Imbalance - blood; Acute Disease; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arteries; Biological and medical sciences; Blood; Blood and lymphatic vessels; Blood Chemical Analysis; Blood pressure; Carbon dioxide; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency; Emergency medical care; Female; Gases; Hemorrhage; Humans; Hypoxia; Intensive care medicine; Male; Medical sciences; Middle Aged; Mortality; Predictive Value of Tests; Prospective Studies; Survival; Survival Analysis; Variables; Veins; Ventilation; Wounds and Injuries - blood; Wounds and Injuries - mortality; Intensive care; Survival; Trauma; Comparative study; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2007.01.024

Abstract Background The arterial base deficit has been demonstrated to be a marker of shock and predictive of survival in injured patients. The venous blood, however, may better reflect tissue perfusion. Its usefulness in trauma is unknown. We compared central venous with arterial blood gas analysis to determine which was a better predictor of survival in injured patients. Methods A prospective, nonrandomized series of acutely injured patients was investigated. Patients who had an arterial blood gas analysis for acid-base determination had a simultaneous central venous blood gas analysis and routine blood tests. Patient demographics, Injury Severity Score, and survival past 24 hours were recorded. Arterial and venous blood samples were analyzed for pH, P co2 , P o2 , HCO3 , hemoglobin-oxygen saturation, base deficit, and lactate. Results One hundred patients were enrolled. There were 76 survivors and 24 nonsurvivors. Wilcoxon rank sum test and multivariate logistic regression were used for each recorded variable; only central venous base deficit was predictive of survival past 24 hours ( P = .0081). Specifically, arterial base deficit was not predictive of survival past 24 hours. Conclusion In a prospective series of acutely injured patients, central venous base deficit, not arterial base deficit, was predictive of survival past 24 hours.