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Fast as a Predictor of Outcomes After Resuscitative Thoracotomy: A Prospective Evaluation
Kenji Inaba*, Konstantinos Chouliaras*, Scott Zakaluzny*, Pedro Teixeira*, Emre Sivrikoz*, Crystal Ives*, Galinos Barmparas*, Nikos Koronakis*, Demetrios Demetriades
LAC+USC, University of Southern California, Los Angeles, CA

OBJECTIVE(S) - Resuscitative thoracotomy (RT) is a high-risk, low-salvage procedure performed in arresting trauma patients. The indications for performing this emergent procedure are poorly defined and are based on low quality primarily retrospective data. The purpose of this study was to examine the ability of FAST to discriminate between survivors and non-survivors undergoing RT after traumatic arrest.
METHODS - All patients undergoing RT from 10/2010-05/2014 were prospectively enrolled. A bedside parasternal/subxiphoid cardiac ultrasound was performed prior to or concurrent with RT. The FAST was captured as equivocal or adequate with the presence/absence of pericardial fluid and/or wall 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. Mean age 35.0 (1-84), 84.5% male, 51.3% penetrating. Loss of vitals occurred in the field in 48.1%, en-route in 24.6% and in the ED in 27.3%. 77.5% underwent emergent left thoracotomy and 22.5% a clamshell. Sustained cardiac activity was regained in 49.7% however overall survival was only 3.2% with 1.6% proceeding to organ donation. FAST was equivocal in 3.7%, 28.9% demonstrated wall motion and 9.1% pericardial fluid. FAST was 100% sensitive and 62% specific for the identification of survivors and potential donors.
CONCLUSIONS - With 100% sensitivity for the detection of survivors after traumatic arrest, FAST represents an effective method of separating those that do not warrant the risk and resource burden of resuscitative thoracotomy from potential survivors. Prospective multicenter validation is warranted.


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