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Focused rapid echocardiographic evaluation versus vascular cather-based assessment of cardiac output and function in critically ill trauma patients

Murthi, Sarah B. MD; Hess, John R. MD, MPH; Hess, Aaron BA; Stansbury, Lynn G. MD, MPH; Scalea, Thomas M. MD

The Journal of Trauma and Acute Care Surgery: May 2012 - Volume 72 - Issue 5 - p 1158–1164
doi: 10.1097/TA.0b013e31824d1112
AAST 2011 Plenary Papers
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BACKGROUND: Focused rapid echocardiographic evaluation (FREE) is a comprehensive transthoracic echocardiogram tailored for the intensive care unit. It assesses both the cardiac index (CI) and left ventricular ejection fraction (EF). FREE and vascular catheter-derived CI was compared, and the ability of CI to detect moderate to severe dysfunction (EF <40%) was determined.

METHODS: FREE quality assurance database was reviewed to identify patients who had a hemodynamic catheter.

RESULTS: Of 507 FREEs, 115 patients were identified, 25 pulmonary artery catheters (PACs) and 90 FloTrac Vigileo (FT/V) arterial catheters. There were 27 patients with an EF <40%. In 86%, the CI was determined by FREE, and it changed care in 59%. The CI correlation for FREE versus PAC was r = 0.88 and versus FT/V was r = 0.63 (p < 0.05). The PAC-FREE bias was −0.07 (95% confidence interval −0.89 to 0.74) and the FT/V-FREE bias was −0.13 (95% confidence interval −1.4 to 1.1). FREE-PAC categorized patients the same way 87% and FREE-FT/V 76%; in patients with EF <40%, this changed to 90% and 63%, respectively. Using a threshold value (CI ≤2.5), the PAC detected dysfunction in 62.5% and the F/VT in 6%, p < 0.05.

CONCLUSIONS: There was excellent agreement between FREE and PAC but less with FT/V, especially in patients with and EF <40%. FREE can be used to validate catheter-derived data and provide important additional information. Further studies are needed to determine its impact on patient outcome.

LEVEL OF EVIDENCE: III, diagnostic study.

Baltimore, Maryland

From the Division of Trauma and Surgical Critical Care (S.B.M., L.G.S., T.M.S.), Department of Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; Departments of Medicine and Pathology (J.R.H.), University of Maryland School of Medicine, Baltimore, Maryland; and Department of Epidemiology (A.H.), University of Maryland School of Medicine, Baltimore, Maryland.

Submitted: September 12, 2011, Revised: November 28, 2011, Accepted: December 1, 2011.

Supported by the John and Maureen Hendricks Grant to support echocardiography in the care of trauma patients and Division of Trauma Program Development Funds.

Presented at the 70th Annual Meeting of the American Association Society of Trauma, September 14–17, 2011, Chicago, Illinois.

Address for reprints: Sarah B. Murthi, MD, FACS, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201; e-mail: smurthi@umm.edu.

© 2012 Lippincott Williams & Wilkins, Inc.