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Use of Shock Index to Identify Mild Hemorrhage: An Observational Study in Military Blood Donors

Published online by Cambridge University Press:  29 April 2019

Pierre Pasquier ,
Sandrine Duron ,
Thomas Pouget ,
Anne-Charlotte Carbonnel ,
Mathieu Boutonnet ,
Brice Malgras ,
Olivier Barbier ,
Guillaume de Saint Maurice ,
Anne Sailliol  and
Sylvain Ausset
...Show all authors
Pierre Pasquier*
Affiliation:
Department of Anesthesiology and Intensive Care, Percy Military Training Hospital, Clamart, France French Military Medical Service Academy, École du Val-de-Grâce, Paris, France
Sandrine Duron
Affiliation:
French Military Centre for Epidemiology and Public Health, Marseille, France
Thomas Pouget
Affiliation:
French Military Blood Institute, Clamart, France
Anne-Charlotte Carbonnel
Affiliation:
French Military Medical Service Academy, École du Val-de-Grâce, Paris, France
Mathieu Boutonnet
Affiliation:
Department of Anesthesiology and Intensive Care, Percy Military Training Hospital, Clamart, France French Military Medical Service Academy, École du Val-de-Grâce, Paris, France
Brice Malgras
Affiliation:
French Military Medical Service Academy, École du Val-de-Grâce, Paris, France Department of Trauma Surgery, Bégin Military Training Hospital, Saint-Mandé, France
Olivier Barbier
Affiliation:
French Military Medical Service Academy, École du Val-de-Grâce, Paris, France Department of Trauma Surgery, Bégin Military Training Hospital, Saint-Mandé, France
Guillaume de Saint Maurice
Affiliation:
Department of Anesthesiology and Intensive Care, Percy Military Training Hospital, Clamart, France French Military Medical Service Academy, École du Val-de-Grâce, Paris, France
Anne Sailliol
Affiliation:
French Military Medical Service Academy, École du Val-de-Grâce, Paris, France French Military Blood Institute, Clamart, France
Sylvain Ausset
Affiliation:
Department of Anesthesiology and Intensive Care, Percy Military Training Hospital, Clamart, France French Military Medical Service Academy, École du Val-de-Grâce, Paris, France
Christophe Martinaud
Affiliation:
French Military Medical Service Academy, École du Val-de-Grâce, Paris, France French Military Blood Institute, Clamart, France
*
Correspondence: Prof. Pierre Pasquier, MD, MSc Dept. of Anesthesiology and Intensive Care Unit Percy Military Teaching Hospital 101 Avenue Henri Barbusse 92140 Clamart, France E-mail: pasquier9606@me.com
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Abstract

Introduction:

Hemorrhage is the leading cause of preventable death in combat, although early recognition of hemorrhage is still challenging on the battlefield.

Hypothesis/Problem:

The objective of this study was to describe the shock index (SI) in a healthy military population, and to measure its variation during a controlled blood loss, simulated by blood donation.

Methods:

A prospective observational study that enrolled military subjects, volunteers for blood donation, was conducted. Demographic and clinical information, concerning both the patient and the blood collection, were recorded. Baseline vital signs were measured, before and after donation, in a 45° supine position. Statistical analysis was performed after calculation of SI.

Results:

A total of 483 participants were included in the study. The mean blood donation volume was 473mL (SD = 44mL). The median pre- and post-blood donation SI were significantly different: 0.54 (IQR = 0.48-0.63) and 0.57 (IQR = 0.49-0.66), respectively (P = .002). Changes in pre-/post-donation blood pressure (BP) and heart rate (HR) also reached statistical difference but represented a clinically poor relevance. The multivariate analysis showed no significant associations between SI variations and age, sex, body mass index (BMI), sport activities, blood donation volume, and enteral volume replacement (EVR).

Conclusion:

In this model of mild hemorrhage, SI exhibited significant variations but failed to reach clinical relevance. Further studies are needed to prove the benefit of SI calculation as a possible parameter for early recognition of hemorrhage in combat casualties at the point of injury.

Pasquier P, Duron S, Pouget T, Carbonnel AC, Boutonnet M, Malgras B, Barbier O, de Saint Maurice G, Sailliol A, Ausset S, Martinaud C. Use of shock index to identify mild hemorrhage: an observational study in military blood donors. Prehosp Disaster Med. 2019;34(3):303–307.

Keywords

blood donationhemodynamicshemorrhagemilitaryshock index
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 3 , June 2019 , pp. 303 - 307
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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