title: Findings of a randomized controlled trial using limited transthoracic echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay.
abstract: BACKGROUND
  We hypothesize that limited transthoracic echocardiogram (LTTE) is a useful tool to guide therapy during the initial phase of resuscitation in trauma patients.
  
  
  METHODS
  All highest-level alert patients with at least one measurement of systolic blood pressure less than 100 mm Hg, a mean arterial pressure less than 60 mm Hg, and/or a heart rate greater than 120 beats per minute who arrived to the trauma bay (TB) were randomized to have either LTTE performed (LTTEp) or not performed (non-LTTE) as part of their initial evaluation. Images were stored, and results were reported regarding contractility (good vs. poor), fluid status (empty inferior vena cava [hypovolemic] vs. full inferior vena cava [not hypovolemic]), and pericardial effusion (present vs. absent). Time from TB to operating room, intravenous fluid administration, blood product requirement, intensive care unit admission, and mortality were examined in both groups.
  
  
  RESULTS
  A total of 240 patients were randomized. Twenty-five patients were excluded since they died upon arrival to the TB, leaving 215 patients in the study. Ninety-two patients were in the LTTEp group with 123 patients in the non-LTTE group. The LTTEp and non-LTTE groups were similar in age (38 years vs. 38.8 years, p = 0.75), Injury Severity Score (ISS) (19.2 vs. 19.0, p = 0.94), Revised Trauma Score (RTS) (5.5 vs. 6.0, p = 0.09), lactate (4.2 vs. 3.6, p = 0.14), and mechanism of injury (p = 0.44). Strikingly, LTTEp had significantly less intravenous fluid than non-LTTE patients (1.5 L vs. 2.5 L, p < 0.0001), less time from TB to operating room (35.6 minutes vs. 79.1 min, p = 0.0006), higher rate of intensive care unit admission (80.4% vs. 67.2%, p = 0.04), and a lower mortality rate (11% vs. 19.5%, p = 0.09). Mortality differences were particularly evident in the traumatic brain injury patients (14.7% in LTTEp vs. 39.5% in non-LTTE, p = 0.03).
  
  
  CONCLUSIONS
  LTTE is a useful guide for therapy in hypotensive trauma patients during the early phase of resuscitation.
  
  
  METHODS
  Therapeutic study, level II.
authors.affiliation: From the Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
authors.forename: David
authors.initials: D
authors.lastname: Evans
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfe
authors.forename: Rahul J
authors.initials: RJ
authors.lastname: Anand
authors.forename: Poornima
authors.initials: P
authors.lastname: Vanguri
authors.forename: Julie
authors.initials: J
authors.lastname: Mayglothling
authors.forename: James
authors.initials: J
authors.lastname: Whelan
authors.forename: Ajai
authors.initials: A
authors.lastname: Malhotra
authors.forename: Stephanie
authors.initials: S
authors.lastname: Goldberg
authors.forename: Therese
authors.initials: T
authors.lastname: Duane
authors.forename: Michel
authors.initials: M
authors.lastname: Aboutanos
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000503:physiopathology; D015601:Injury Severity Score; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*