SonoStudy: >29,000 patients: Utility of cardiac portion of FAST scan: should we be doing it?

Should we keep doing the echo with the FAST scan? What does it truly add? Ill never forget the story I heard about a 35 yr old male blunt trauma victim after single vehicle motor vehicle accident who lost his pulse en route.  The echo part of the FAST scan showed tamponade in the first 5 minutes of evaluation and ACLS/ATLS management. He survived due to early pick up) and walked out of the hospital. Or, the penetrating epigastric stab wound victim who was tachycardic and hypotensive with no tamponade or pericardial effusion seen on FAST (helping us rule out tamponade as the cause of shock). But, when looking at the studies….a recent one from JEM states:

“Background

Focused assessment with sonography in trauma (FAST) is widely used and endorsed by guidelines, but little evidence exists regarding the utility of the cardiac portion in blunt trauma. The traditional FAST includes the routine performance of cardiac sonography, regardless of risk for hemopericardium.

Study Objectives

Our goal was to estimate the prevalence of hemopericardium due to blunt trauma and determine the sensitivity of certain variables for the presence of blunt hemopericardium.

Methods

We performed a retrospective chart review of two institutional databases at a large urban Level I trauma center to determine the prevalence of blunt hemopericardium and cardiac rupture and incidental or insignificant effusions. We evaluated the sensitivity of major mechanism of injury, hypotension, and emergent intubation for blunt hemopericardium and cardiac rupture.

Results

Eighteen patients had hemopericardium and cardiac rupture (14 and 4, respectively) out of 29,236 blunt trauma patients in the Trauma Registry over an 8.5-year period. The prevalence was 0.06% (95% confidence interval [CI] 0.04–0.09%). The prevalence of incidental or insignificant effusions was 0.13% (95% CI 0.09–0.18%). One case of blunt hemopericardium was identified in the emergency ultrasound database out of 777 cardiac ultrasounds over a 3-year period. No patient with blunt hemopericardium or cardiac rupture presented without a major mechanism of injury, hypotension, or emergent intubation.

Conclusion

Blunt hemopericardium is rare. High-acuity variables may help guide the selective use of echocardiography in blunt trauma.”

So, I would ask: is it worth the 20 seconds it takes to look at the heart to pick up those patients who had a positive scan? And, is it worth the 20 seconds it takes to look at the heart to rule it out? – i say – yes. But I get it – it may be negative A LOT of the time.

2 thoughts on “SonoStudy: >29,000 patients: Utility of cardiac portion of FAST scan: should we be doing it?

  1. I think the days of the “YES or NO” fluid use of the FAST are gone (or should be).

    I get a lot more information from just a 15 second glance at the heart that hemopericardium or not…I like to know about ‘squeeze’, for example, before any intubation in blunt trauma.

    I think getting rid of the stethoscope should be argued for way before we try to get rid of the cardiac view in trauma.

    Hamhock

    • Hamhock, thanks for your comment, and what the stethoscope provides can be done with the ultrasound machine – I agree. I will still want to look for hemopericardium, cardiac activity in traumatic arrest, and if contractility benefits the work up and management (particularly of the elderly patient) then go for it! More information is better than not enough. Happy scanning!

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