• Ross Prager, Eric Walser, Kaan Y Balta, M D Anton Nikouline, William R Leeper, Kelly Vogt, Neil Parry, and Robert Arntfield.
• Western University, Division of Critical Care, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, Stn Z, London, ON N6A 5A5, United Kingdom. Electronic address: Ross.Prager@lhsc.on.ca.
• J Crit Care. 2024 Feb 1; 79: 154426154426.

BackgroundResuscitative transesophageal echocardiography (TEE) is an emerging POCUS modality that can be used to guide trauma resuscitation.MethodsTrauma patients who underwent TEE within 24 h of admission from 2013 to 2022 were prospectively identified. We retrospectively analyzed resuscitative TEE reports and patient charts in duplicate.Results29 providers performed TEE for 54 acute trauma patients. 28 (52%) died in hospital; 33 (61%) required operative intervention (<24 h). Median injury severity score was 29 [IQR 22-43]. The most common indications for TEE were hemodynamic instability (34, 63%), inadequate windows for transthoracic echocardiography (14, 26%) and cardiac arrest (11, 20%). There were no identified complications. A new diagnosis was made in 31 (57%) cases: most commonly right ventricular dysfunction (10, 19%), pericardial effusion (9, 17%), and hypovolemia (6, 11%). TEE ruled out major cardiac injury in 83% of cases. TEE changed resuscitative strategy, in 17 (32%) patients, diagnostic imaging approach in 6 (11%) patients, procedural or operative approach in 5 (9%) patients and disposition from the trauma bay in 4 (7%) patients.ConclusionResuscitative TEE during acute trauma care has an additional diagnostic yield to existing diagnostic pathways and may impact definitive management for some patients in the trauma bay.Copyright © 2023 Elsevier Inc. All rights reserved.

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