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ISBI- Transthoracic Echo

ISBI presentation, 2012

1 of 14
DEPARTMENT OF SURGERY




Feasibility of limited echocardiography
   during burn shock resuscitation

   Amalia Cochran, MD, FACS, FCCM
     Iris Faraklas, RN, BSN, CCRN
     Stephen E. Morris, MD, FACS
DEPARTMENT OF SURGERY




Background
• Optimization of resuscitation from burn
  shock remains a fundamental challenge
• Non-cardiologists can be trained
  successfully to obtain and interpret
  echocardiographic images (Beaulieu, 2007)
• Recent publication shows efficacy of
  limited transthoracic echo in trauma
  resuscitation (Ferrada, 2011)
DEPARTMENT OF SURGERY




Study goal
• Demonstrate efficacy of limited
  transthoracic echo (TTE) to monitor burn
  shock resuscitation in patients with major
  burn injury
  – Volume status
  – Contractility
DEPARTMENT OF SURGERY




Methods
• Adult patients with >20% TBSA injury over
  a 14 month period
• Limited TTE performed at 6, 12, 18, and
  24 hours following injury
  – 5 views
DEPARTMENT OF SURGERY
DEPARTMENT OF SURGERY




Results
•   13 patients with at least 3 of 4 data points
•   All male
•   54% with flame injury
•   Median age 35 years (IQR 24-46)
•   Median TBSA 28% (IQR 23-45.5)
•   10 with anterior torso burns
•   9 on mechanical ventilation

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ISBI- Transthoracic Echo

  • 1. DEPARTMENT OF SURGERY Feasibility of limited echocardiography during burn shock resuscitation Amalia Cochran, MD, FACS, FCCM Iris Faraklas, RN, BSN, CCRN Stephen E. Morris, MD, FACS
  • 2. DEPARTMENT OF SURGERY Background • Optimization of resuscitation from burn shock remains a fundamental challenge • Non-cardiologists can be trained successfully to obtain and interpret echocardiographic images (Beaulieu, 2007) • Recent publication shows efficacy of limited transthoracic echo in trauma resuscitation (Ferrada, 2011)
  • 3. DEPARTMENT OF SURGERY Study goal • Demonstrate efficacy of limited transthoracic echo (TTE) to monitor burn shock resuscitation in patients with major burn injury – Volume status – Contractility
  • 4. DEPARTMENT OF SURGERY Methods • Adult patients with >20% TBSA injury over a 14 month period • Limited TTE performed at 6, 12, 18, and 24 hours following injury – 5 views
  • 6. DEPARTMENT OF SURGERY Results • 13 patients with at least 3 of 4 data points • All male • 54% with flame injury • Median age 35 years (IQR 24-46) • Median TBSA 28% (IQR 23-45.5) • 10 with anterior torso burns • 9 on mechanical ventilation
  • 7. DEPARTMENT OF SURGERY Six-Hour post-injury images Adequate Marginal Poor Parasternal 11 0 1 Long axis Parasternal 9 2 1 Short axis Apical 9 3 0 4-Chamber Subcostal 4 4 4 4-Chamber Subcostal 7 2 3 IVC N= 12
  • 8. DEPARTMENT OF SURGERY Twelve-Hour post-injury images Adequate Marginal Poor Parasternal 10 1 0 Long axis Parasternal 8 2 1 Short axis Apical 8 3 0 4-Chamber Subcostal 7 4 0 4-Chamber Subcostal 7 4 0 IVC N= 11
  • 9. DEPARTMENT OF SURGERY Eighteen-Hour post-injury images Adequate Marginal Poor Parasternal 10 3 0 Long axis Parasternal 8 4 1 Short axis Apical 8 3 2 4-Chamber Subcostal 7 4 2 4-Chamber Subcostal 7 5 1 IVC N= 13
  • 10. DEPARTMENT OF SURGERY Twenty-Four Hour post-injury images Adequate Marginal Poor Parasternal 11 0 1 Long axis Parasternal 7 3 2 Short axis Apical 9 2 1 4-Chamber Subcostal 7 5 0 4-Chamber Subcostal 10 1 1 IVC N= 12
  • 11. DEPARTMENT OF SURGERY Volume status findings • Volume status could be described in 46 of 48 studies (96%) • CVP estimates were possible in 46 of 48 studies – CVP estimates correlated with measured CVP in 24/30 measurements – Accuracy progressively improved – All inaccurate estimates were underestimates
  • 12. DEPARTMENT OF SURGERY Contractility findings • Contractility could be evaluated in 47/48 studies (98%) • Two hyperdynamic patients – One from 12 hours on – Another at 18 and 24 hours only • One with decreased pump function throughout – History of CHF, volume overloaded at 24 hours
  • 13. DEPARTMENT OF SURGERY Conclusions • Limited TTE is easily performed in burn patients – Even those with anterior torso burns and/ or on mechanical ventilation • Data provide a helpful adjunct during resuscitation for evaluation of volume status and contractility • Future work- echo to help guide resuscitation?