title: FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation.
abstract: OBJECTIVE
  The objective of this study was to examine the ability of Focused Assessment Using Sonography for Trauma (FAST) to discriminate between survivors and nonsurvivors undergoing resuscitative thoracotomy (RT).
  
  
  BACKGROUND
  RT is a high-risk, low-salvage procedure performed in arresting trauma patients with poorly defined indications.
  
  
  METHODS
  Patients undergoing RT from 10/2010 to 05/2014 were prospectively enrolled. A FAST examination including parasternal/subxiphoid cardiac views was performed before or concurrent with RT. The result was captured as adequate or inadequate with presence or absence of pericardial fluid and/or cardiac motion. A sensitivity analysis utilizing the primary outcome measure of survival to discharge or organ donation was performed.
  
  
  RESULTS
  Overall, 187 patients arrived in traumatic arrest and underwent FAST. Median age 31 (1-84), 84.5% male, 51.3% penetrating. Loss of vital signs occurred at the scene in 48.1%, en-route in 23.5%, and in the ED in 28.3%. Emergent left thoracotomy was performed in 77.5% and clamshell thoracotomy in 22.5%. Sustained cardiac activity was regained in 48.1%. However, overall survival was only 3.2%. An additional 1.6% progressed to organ donation. FAST was inadequate in 3.7%, 28.9% demonstrated cardiac motion and 8.6% pericardial fluid. Cardiac motion on FAST was 100% sensitive and 73.7% specific for the identification of survivors and organ donors.
  
  
  CONCLUSIONS
  With a high degree of sensitivity for the detection of potential survivors after traumatic arrest, FAST represents an effective method of separating those that do not warrant the risk and resource burden of RT from those who may survive. The likelihood of survival if pericardial fluid and cardiac motion were both absent was zero.
authors.affiliation: *Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA †Department of Emergency Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Chouliaras
authors.forename: Scott
authors.initials: S
authors.lastname: Zakaluzny
authors.forename: Stuart
authors.initials: S
authors.lastname: Swadron
authors.forename: Thomas
authors.initials: T
authors.lastname: Mailhot
authors.forename: Dina
authors.initials: D
authors.lastname: Seif
authors.forename: Pedro
authors.initials: P
authors.lastname: Teixeira
authors.forename: Emre
authors.initials: E
authors.lastname: Sivrikoz
authors.forename: Crystal
authors.initials: C
authors.lastname: Ives
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koronakis
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods*; D018608:Ultrasonography, Doppler / Q000379:methods*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*