Exclusion of aortic tear in the unstable trauma patient: the utility of transesophageal echocardiography.

OBJECTIVE: The goal of this study was to investigate the value of biplanar transesophageal echocardiography (TEE) as a screening tool for aortic tear in unstable trauma patients.

METHODS: During a 1-year period, a prospective trial to exclude aortic tear was conducted at a level I trauma center. Ten of 53 patients (19%) sustaining severe blunt thoracic trauma were deemed too unstable to undergo safe transport to aortography and underwent TEE. Mechanism of injury was motor vehicle crash in eight patients and pedestrians struck in two. Patients had a mean Injury Severity Score = 34 (range, 17 to 59) and mean age = 43 years (range, 18 to 77). Indications for aortic tear evaluation were chest x-ray findings in seven and mechanism of injury alone in three. Patients were not transportable because of hemodynamic instability in five individuals, severe unstable head injury in three individuals, and unstable cervical spine fracture in two individuals.

RESULTS: Transesophageal echocardiography was performed in the emergency department in one instance, in the operating room in one instance, and in the surgical intensive care unit in the remaining eight instances. Patients underwent the procedure less than 8 hours after admission in seven and more than 48 hours after admission in three. One patient had a complication during TEE (ventricular dysrhythmias). In one of ten patients, TEE was positive. This patient required medical management (beta-blockade) for aortic tear until severe hypoxia secondary to pulmonary contusion improved after 36 hours. Repair of aortic tear was then successfully performed.

CONCLUSIONS: The TEE procedure is valuable in identifying aortic injury in high-risk trauma patients who are too unstable to undergo transport to the aortography suite.