Dr Scott Farenden1, Dr Christopher Partyka1, Dr Angus Perks
1New South Wales Ambulance Service, Sydney, Australia, 2Nottingham University Hospitals, Nottingham, United Kingdom
Abstract:
Aims:
Traumatic brain injury (TBI) can cause significant hemodynamic compromise. Brain injury associated shock (BIAS) occurs in 13% of adult trauma populations(1), and approximately 40% of cases in major pediatric trauma(2). We sought to identify whether echocardiography could differentiate BIAS from other causes of traumatic shock in the prehospital setting.
Methods:
We conducted an eight year retrospective review of prehospital trauma cases at NSW Ambulance (Aeromedical Operations) between 2016 and 2023. Adult cases with head/facial injuries, GCS≤12 and recorded prehospital echos were screened. Inclusion criteria were shock (systolic BP <100mmHg or those receiving blood products or vasopressors) and confirmed TBI on follow up imaging. Pregnant patients, any who died prior to hospital arrival and those with alternative causes for shock were excluded.
Results:
Of 5,616 screened patients, nine met inclusion criteria. Of these cases, only one had an interpretable recorded echocardiographic video uploaded to the clinical database. Of interest, this case did demonstrate significant cardiac dysfunction in the context of a patient with isolated TBI receiving large volumes of blood products for refractory shock.
Conclusions:
We had insufficient data to make any meaningful inference about the utility of prehospital echocardiography in the identification of BIAS. Given that severe TBI remains the leading cause of death and disability following trauma and that in-hospital echocardiography has been shown to reduce mortality(3), we believe there may be opportunity to enhance patient outcomes through prehospital echocardiographic assessment. We propose the establishment of an international registry of BIAS case echocardiography to research this further.
Biographies:
Biographies to come