Introduction: Cardiac ultrasonography has been suggested as an adjunct tool in the early assessment of pulseless trauma victims to aid in prognosis. Several studies show that patients with an organized cardiac rhythm on ultrasound despite pulselessness have a higher probability of survival, yet the value of cardiac serial functional assessment with point of care ultrasonography (POCUS) in ongoing trauma resuscitation has not been described. Methods: This study aims to demonstrate the practical use of serial POCUS assessments, in the setting of trauma resuscitation. We describe three cases where patient care was affected using POCUS. Results: The first case is of a 27 year old male who sustained a stab wound to the left upper extremity. The patient was brought in by EMS after a witnessed traumatic arrest in the field where CPR had been performed for >30 minutes. On arrival to the hospital POCUS showed organized cardiac activity with an ejection fraction >80%. This prompted further care, when cessation of resuscitation efforts could have been justified under contemporary NAESMP guidelines. In another case, a 32 year old male presenting with penetrating trauma, POCUS was used intraoperatively when the patient became profoundly hypotensive (SBP80%. Chest compressions were withheld because of this US finding and MTP was resumed with a rapid blood transfuser until hemostasis could be achieved operatively. The last case is a 29 year old male presenting with penetrating trauma to the left hip. Multiple transfusions were administered and the patient was taken to the operating room. Despite multiple transfusions the patient became profoundly hypotensive in the operative room (SBP< 90). Intraoperative POCUS revealed transfusion associated cardiovascular overload, prompting transfusion cessation, increasing norepinephrine dosing, and initiating vasopressin with hemodynamic improvement. Conclusions: This case series demonstrates the feasibility of using POCUS to guide resuscitation. It highlights the need to revisit current guidelines of traumatic cardiac arrest and revise the approach to pulseless hypovolemia with early and ongoing assessment of resuscitation with POCUS.
Andry et al. (Sun,) studied this question.