EXCLUSION OF AORTIC TEAR IN THE UNSTABLE TRAUMA PATIENT - THE UTILITYOF TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Objective: The goal of this study was to investigate the value of bipl anar transesophageal echocardiography (TEE) as a screening tool for ao rtic tear in unstable trauma patients, Methods: During a 1-year period , a prospective trial to exclude aortic tear was conducted at a level I trauma center, Ten of 53 patients (19%) sustaining severe blunt thor acic trauma were deemed too unstable to undergo safe transport to aort ography and underwent TEE, Mechanism of injury was motor vehicle crash in eight patients and pedestrians struck in two, Patients had a mean Injury Severity Score = 34 (range, 17 to 59) and mean age = 43 years ( range, 18 to 77), Indications for aortic tear evaluation were chest x- ray findings in seven and mechanism of injury alone in three, Patients were not transportable because of hemodynamic instability in five ind ividuals, severe unstable head injury in three individuals, and unstab le cervical spine fracture in two individuals, Results: Transesophagea l echocardiography was performed in the emergency department in one in stance, in the operating room in one instance, and in the surgical int ensive care unit in the remaining eight instances, Patients underwent the procedure less than 8 hours after admission in seven and more than 48 hours after admission in three, One patient had a complication dur ing TEE (ventricular dysrhythmias). In one of ten patients, TEE was po sitive, This patient required medical management (beta-blockade) for a ortic tear until severe hypoxia secondary to pulmonary contusion impro ved after 36 hours, Repair of aortic tear was then successfully perfor med. Conclusions: The TEE procedure is valuable in identifying aortic injury in high-risk trauma patients who are too unstable to undergo tr ansport to the aortography suite.