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Prager R, Walser E, Balta KY, Anton Nikouline MD, Leeper WR, Vogt K, Parry N, Arntfield R. Resuscitative transesophageal echocardiography during the acute resuscitation of trauma: A retrospective observational study. J Crit Care 2024; 79:154426. [PMID: 37757671 DOI: 10.1016/j.jcrc.2023.154426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Resuscitative transesophageal echocardiography (TEE) is an emerging POCUS modality that can be used to guide trauma resuscitation. METHODS Trauma patients who underwent TEE within 24 h of admission from 2013 to 2022 were prospectively identified. We retrospectively analyzed resuscitative TEE reports and patient charts in duplicate. RESULTS 29 providers performed TEE for 54 acute trauma patients. 28 (52%) died in hospital; 33 (61%) required operative intervention (<24 h). Median injury severity score was 29 [IQR 22-43]. The most common indications for TEE were hemodynamic instability (34, 63%), inadequate windows for transthoracic echocardiography (14, 26%) and cardiac arrest (11, 20%). There were no identified complications. A new diagnosis was made in 31 (57%) cases: most commonly right ventricular dysfunction (10, 19%), pericardial effusion (9, 17%), and hypovolemia (6, 11%). TEE ruled out major cardiac injury in 83% of cases. TEE changed resuscitative strategy, in 17 (32%) patients, diagnostic imaging approach in 6 (11%) patients, procedural or operative approach in 5 (9%) patients and disposition from the trauma bay in 4 (7%) patients. CONCLUSION Resuscitative TEE during acute trauma care has an additional diagnostic yield to existing diagnostic pathways and may impact definitive management for some patients in the trauma bay.
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Affiliation(s)
- Ross Prager
- Western University, Division of Critical Care, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
| | - Eric Walser
- Western University, Department of Surgery, Division of Critical Care Medicine, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria HospitalLondon Health Sciences Centre, 800 Commissioners Road, East PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Kaan Y Balta
- Western University, Faculty of Medicine, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
| | - M D Anton Nikouline
- Western University, Division of Emergency Medicine, Division of Critical Care Medicine, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria HospitalLondon Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - William R Leeper
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Kelly Vogt
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Neil Parry
- Western University, Department of Surgery, London Health Sciences Centre, Trauma Program, Room E1-129, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9, United Kingdom.
| | - Robert Arntfield
- Western University, Division of Critical Care, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom.
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