Supporting the early use of echocardiography in blunt chest trauma

Trauma is the third leading cause of death in the under-40 age group in the United States, with blunt force trauma being a very common mechanism. For example, in the United States, 25% of all fatalities have arisen from a form of chest trauma in general [1]. More specifically, chest injury has been cited as the most important injury of polytraumas with an incidence of 45% to 65% and an associated mortality of up to 60% [2]. Blunt chest trauma is a common result of impact and deceleration injuries such as motor vehicle accidents, falls, crush injuries, occupational exposures and sporting hazards [1-5]. Incidentally, blunt chest trauma is more common than penetrating chest trauma in the United States [1]. Cardiac rupture following blunt chest trauma is an exceedingly uncommon consequence but is associated with an extremely high mortality [5].The first repair of a cardiac rupture following blunt trauma occurred in 1955; however, only a paucity of series reviewing the outcomes post-rupture have been undertaken since this initial case [1]. Mortality from cardiac rupture following blunt chest trauma has been reported to be as high as 81.3% to 85% [6,7]. A 5-year study of blunt cardiac rupture cases revealed that of the 32 cases reviewed, 20 presented in cardiac arrest (non-survivors), and of those who presented with vital signs, only 6 survived [5]. Another retrospective study of 160 autopsy cases showed that of the 40 fatalities from blunt chest trauma, approximately 5？% made it to the hospital alive, with the majority dying at the scene (86%) or during retrieval (approximately 8%) [4]. Similar figures of 80% early death have been reported in similar studies [1]. Shorr et al also reported a 100% (39/39) unsuccessful resuscitative thoracotomy rate in presentations without vital signs [1]. Cardiac injury distribution following blunt chest trauma was widely varied in two large retrospective studies reviewed. Right atrial rupture accounted for 5% and 40.6%, left atrial ruptu