This Sept 2015 Annals of Surgery article made a splash when it first came out a year ago, and it came up again yesterday in conference. Here’s a refresher.
FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation” by Inabi et al.
Inabi and company looked at 187 traumatic arrests at LA County from 2010-2014. They all underwent a FAST exam and a resuscitative thoractomy. 51.3% of the traumatic arrests were penetrating. 28.9% or 45 patients had cardiac motion or pericardial effusion on their FAST, and 9 of these patients survived or became organ donors. Most notably, 0% of patients who had no cardiac motion or pericardial effusion on FAST survived. Thus, cardiac motion on FAST was 100% sensitive and 73.7% specific for the identification of survivors and organ donors.
What’s the take-home? Whether penetrating or blunt, if you don’t find cardiac motion or pericardial effusion on your bedside sono, this is pretty decent evidence that we should not proceed with resuscitative thoracotomy. Chances are slim (nonexistent, in fact).
Of course, yesterday in conference, we were discussing the converse corollary, which may or may not necessarily be true (based on mathematics and this research), but we’re at an academic level I trauma center with plenty of trainees. If you have blunt trauma with signs of life and cardiac motion or effusion on your bedside sono, perhaps this can be evidence that we should proceed with thoracotomy, which always seems to be the harder decision.
Sources
http://journals.lww.com/annalsofsurgery/Abstract/2015/09000/FAST_Ultrasound_Examination_as_a_Predictor_of.13.aspx
The Predictive Ability of the FAST Examination in Traumatic Cardiac Arrest
https://www.emrap.org/episode/thoracotomy/thoracotomy
