The Prognostic Value of Limited Transthoracic Echocardiogram (LTTE) During Trauma Resuscitation

Primary caregiver thoracic ultrasound (U/S) is a skill which is growing in utility in
critical care. First introduced for volume assessment in nephrology and cardiology, it is
now being researched in emergency and critical care. Data is still evolving in its use in
initial trauma evaluation. Inferior vena cava (IVC) diameter correlates with outcome in
trauma, but utility of its measurement on U/S in the emergency department still has some
controversy. In trauma specifically, small studies suggests benefit to the use of U/S to
predict volume status, and most of these data are from one author. It is not known if this
can be applied more broadly. The prognostic value of findings on limited transthoracic
echocardiogram (LTTE, SonoSite Ultrasound) has been studied in several small studies, and
only one small randomized controlled trial has proven benefit to its use. Due to inter-rater
reliability and the fact that all reports on credentialing of thoracic ultrasound use in the
trauma bay are from one group, it is not known if it can be applied to all trauma
populations.

Research question:

Does LTTE (SonoSite Ultrasound) predict mortality, emergency surgery, intensive care unit
(ICU) stay, hospital stay, time on ventilator, number of transfusions, or renal failure as
well as or better than other methods of organ perfusion?

Hypotheses:

1. Use of LTTE is associated with improved outcomes (less organ failure, decreased
hospital and ICU stays, transfusions, and mortality).

2. LTTE predicts mortality, emergency surgery, ICU stay, hospital stay, time on
ventilator, number of and transfusions better than other methods of organ perfusion
(tachycardia, hypotension, lactate, lactate clearance, creatinine, base deficit).