title: Use of limited transthoracic echocardiography in patients with traumatic cardiac arrest decreases the rate of nontherapeutic thoracotomy and hospital costs.
abstract: OBJECTIVE
  Limited transthoracic echocardiography (LTTE) has been introduced as a hemodynamic tool for trauma patients. The aim of this study was to evaluate the utility of LTTE during the evaluation of nonsurviving patients who presented to the trauma bay with traumatic cardiac arrest.
  
  
  METHODS
  Approval by the Institutional Review Board was obtained. All nonsurviving patients with traumatic cardiac arrest who reached the trauma bay were evaluated retrospectively for 1 year. Comparisons between groups of patients in whom LTTE was performed as part of the resuscitation effort and those in whom it was not performed were conducted.
  
  
  RESULTS
  From January 2012 to January 2013, 37 patients did not survive traumatic cardiac arrest while in the trauma bay: 14 in the LTTE group and 23 in the non-LTTE group. When comparing the LTTE and non-LTTE groups, both were similar in sex distribution (LTTE, 86% male; non-LTTE, 74% male; P = .68), age (34.8 versus 24.1 years; P= .55), Injury Severity Score (41.0 versus 38.2; P= .48), and percentage of penetrating trauma (21.6% versus 21.7%; P = .29). Compared with the non-LTTE group, the LTTE group spent significantly less time in the trauma bay (13.7 versus 37.9 minutes; P = .01), received fewer blood products (7.1% versus 31.2%; P = .789), and were less likely to undergo nontherapeutic thoracotomy in the emergency department (7.14% versus 39.1%; P < .05). The non-LTTE group had a mean of $3040.50 in hospital costs, compared with the mean for the LTTE group of $1871.60 (P = .0054).
  
  
  CONCLUSIONS
  In this study, image-guided resuscitation with LTTE decreased the time in the trauma bay and avoided nontherapeutic thoracotomy in nonsurviving trauma patients. Limited TTE could improve the use of health care resources in patients with traumatic cardiac arrest.
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA. pferrada@mcvh-vcu.edu.
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfe
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA.
authors.forename: Rahul J
authors.initials: RJ
authors.lastname: Anand
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA.
authors.forename: James
authors.initials: J
authors.lastname: Whelan
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA.
authors.forename: Poornima
authors.initials: P
authors.lastname: Vanguri
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA.
authors.forename: Ajai
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Goldberg
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA.
authors.forename: Therese
authors.initials: T
authors.lastname: Duane
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, Virginia Commonwealth University, Richmond, Virginia USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Aboutanos
mesh_terms: D000328:Adult; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000401:mortality; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D013908:Thoracotomy / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000150:complications; D014950:Wounds, Penetrating / Q000150:complications
keywords: cardiac sonography; echocardiography and resuscitation; echocardiography in trauma; echocardiography in traumatic cardiac arrest; emergency ultrasound; limited echocardiography; traumatic cardiac arrest