FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation

Kenji Inaba, Konstantinos Chouliaras, Scott Zakaluzny, Stuart Swadron, Thomas Mailhot, Dina Seif, Pedro Teixeira, Emre Sivrikoz, Crystal Ives, Galinos Barmparas, Nikolaos Koronakis, Demetrios Demetriades
Annals of Surgery 2015, 262 (3): 512-8; discussion 516-8

OBJECTIVE: The objective of this study was to examine the ability of Focused Assessment Using Sonography for Trauma (FAST) to discriminate between survivors and nonsurvivors undergoing resuscitative thoracotomy (RT).

BACKGROUND: RT is a high-risk, low-salvage procedure performed in arresting trauma patients with poorly defined indications.

METHODS: Patients undergoing RT from 10/2010 to 05/2014 were prospectively enrolled. A FAST examination including parasternal/subxiphoid cardiac views was performed before or concurrent with RT. The result was captured as adequate or inadequate with presence or absence of pericardial fluid and/or cardiac motion. A sensitivity analysis utilizing the primary outcome measure of survival to discharge or organ donation was performed.

RESULTS: Overall, 187 patients arrived in traumatic arrest and underwent FAST. Median age 31 (1-84), 84.5% male, 51.3% penetrating. Loss of vital signs occurred at the scene in 48.1%, en-route in 23.5%, and in the ED in 28.3%. Emergent left thoracotomy was performed in 77.5% and clamshell thoracotomy in 22.5%. Sustained cardiac activity was regained in 48.1%. However, overall survival was only 3.2%. An additional 1.6% progressed to organ donation. FAST was inadequate in 3.7%, 28.9% demonstrated cardiac motion and 8.6% pericardial fluid. Cardiac motion on FAST was 100% sensitive and 73.7% specific for the identification of survivors and organ donors.

CONCLUSIONS: With a high degree of sensitivity for the detection of potential survivors after traumatic arrest, FAST represents an effective method of separating those that do not warrant the risk and resource burden of RT from those who may survive. The likelihood of survival if pericardial fluid and cardiac motion were both absent was zero.

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