FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy

Inaba, Kenji; Chouliaras, Konstantinos; Zakaluzny, Scott; Swadron, Stuart P.; Mailhot, Thomas; Seif, Dina; Teixeira, Pedro G.; Sivrikoz, Emre; Ives, Crystal; Barmparas, Galinos; Koronakis, Nikolaos; Δημητριάδης, Δημήτριος

doi:10.1097/sla.0000000000001421

Cited by 57 publications

(34 citation statements)

References 35 publications

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“…Perhaps ultrasound may aid a better identification of potential survivors, as a recent study showed that the absence of both cardiac motility and pericardial effusion on transthoracic ultrasound is associated with zero survivors 13 . On the other side, precious time may be lost while performing ultrasound which may even affect neurological outcome.…”

Section: Discussionmentioning

confidence: 99%

Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

Vledder

Waes

Kooij

et al. 2017

Injury

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Section: Discussionmentioning

confidence: 99%

Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

Vledder

Waes

Kooij

et al. 2017

Injury

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“… 15 17 18 Initial utilization of the focused assessment with sonography for trauma (FAST) may potentially avoid this futile intervention as the absence of cardiac motion or pericardial effusion on a FAST examination results in a zero survival rate. 19 Although it may be able to identify patients with a survival potential, it does not necessarily predict survival in those ultimately undergoing ERT. Nonetheless, clinicians perform this procedure in an effort to expertly weigh the last chance of survival against the risk of rescuing patients with anoxic brain injury.…”

Section: Introductionmentioning

confidence: 99%

Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program

Joseph

Khan

Jehan

et al. 2018

Trauma Surg Acute Care Open

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BackgroundAdvancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT.MethodsA 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program. Outcome measures were utilization rates and survival trends after ERT during the 5-year period. Regression analysis was performed.Results2229 patients underwent ERT, mean age was 37±17 years, 81% were male. Overall 56% patients had penetrating mechanism, location of major injury was thorax in 48, and 71% had signs of life (SOL) on arrival. The overall survival rate was 9.6%. From 2010–2014 ERT utilization has decreased from 331/100 000 to 243/100 000 trauma admissions (p=0.002) and the survival rate has improved from 7.9% to 11.3% (p<0.001). On regression, the independent predictors of survival were penetrating mechanism, age<60 years, SOL on arrival, no prehospital CPR and ISS. No patient aged >60 years with a blunt mechanism of injury (MOI) survived, and there were no survivors above the age of 70 years, regardless of injury mechanism.DiscussionUtilization of ERT has been decreased during the study period along with improved survival rates. The results of our study demonstrate that performing ERT on patients aged >60 years with a blunt MOI or on any patient aged ≥70 years, regardless of MOI, is futile and should be avoided.Level of evidenceLevel III, prognostic studies.

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“…In addition, resuscitative thoracotomies convey a measurable risk to physician staff performing the procedure 12 . Previous work has been done on attempts to identify patients with higher chances of survival including point‐of‐care ultrasound; however, a persistent limitation in the care of these patients is the lack of reliable total downtime 13 . Our data suggest that the use of the novel app that is currently available can almost always provide further details surrounding a traumatic arrest.…”

Section: Discussionmentioning

confidence: 90%

Improving out‐of‐hospital notification in traumatic cardiac arrests with novel usage of smartphone application

Kelly

Clare

2020

JACEP Open

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Introduction Timely out‐of‐hospital notifications in patients with traumatic cardiac arrest are associated improvements in mortality. Details surrounding these events are often limited, and decisions to perform advanced resuscitative procedures must be made based on limited data. This study evaluated the ability of a mobile application (app) called Citizen (sp0n Inc., New York, NY) to address these issues by providing a novel, secondary source of out‐of‐hospital information in traumatic cardiac arrest. Citizen sends notifications to mobile devices in response to nearby detected public safety events, and we sought to evaluate its utility in prenotification for traumatic cardiac arrest. Methods This was a retrospective observational study. Patients ≥ 15 years of age with traumatic cardiac arrest attributed to penetrating trauma were included. The 2 coprimary outcomes observed were the time difference between the app notification and emergency medical services notification, and the app's success rate in generating a notification for each patient in traumatic cardiac arrest. Results From February 2, 2019 to October 10, 2019, there were 43 patients who met the criteria for this study. On average, the Citizen app notification arrived 12.9 minutes before emergency medical services radio notification (95% confidence interval, 9.2–16.6; P < 0.001). Citizen generated a notification for 36 of 43 patients (84%). Conclusion The Citizen app generates earlier notifications in traumatic cardiac arrest compared with standard radio communications. It also provides a previously unavailable secondary source of information for making rapid resuscitative decisions upon the arrival of the arresting patient to the emergency department. Further research is needed to determine how to optimally integrate the app into existing trauma systems.

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FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy

Cited by 57 publications

References 35 publications

Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program

Improving out‐of‐hospital notification in traumatic cardiac arrests with novel usage of smartphone application

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