Skip to content

Research at St Andrews


Research output: Contribution to journalArticle


P S C Rees, D P Inwald, S D Hutchings

School/Research organisations


Introduction Casualties presenting to a military intensive care unit (ICU) following severe traumatic injury suffer haemodynamic instability requiring volume resuscitation. Volume status in critically ill patients is difficult to determine, and formal cardiac output monitoring is not available in the deployed military ICU. Focused transthoracic echocardiography (fTTE) can be used to assess haemodynamic status in critical care settings. We describe a study carried out in a military hospital in Afghanistan, examining the use of echocardiography during damage control resuscitation.Objectives To assess the feasibility of focused TTE (fTTE) in monitoring the response to volume infusion during damage control resuscitation following severe trauma.Methods Ethical approval was gained for this study. fTTE was performed on ventilated patients admitted following severe traumatic injury. A baseline fTTE was performed on admission and repeated after volume resuscitation. fTTE images were independently verified, and data were collected on mechanism of injury, fTTE view availability, and fTTE-derived haemodynamic variables. Doppler of the left ventricular outflow tract (LVOT) was performed to assess respiratory variation of peak LVOT velocity and the velocity time integral (VTi), as markers of filling status. Inferior vena cava (IVC) respiratory variability was also assessed.Results 23 patients were recruited, and 41 studies performed. Injury patterns were: blast 53%, gunshot wound 25%, combined 22%. fTTE windows acquired were: Parasternal long axis 94%, parasternal short axis 86%, apical 4 chamber 66%, subcostal 77%. IVC imaging was possible in 85%, and Doppler interrogation of the LVOT achieved in 73%. Mean baseline parameters were: heart rate 107.4, BP 106/58, CVP 5.2, LV fractional shortening 33.98±2.15%, LVOT VTi variability 22.58±3.02%, LVOT peak velocity variability 18.87±2.14%, IVC variability 23.32±6.76%. Post-resuscitation parameters following a mean fluid bolus of 728±111 ml revealed no significant changes in blood pressure, CVP or heart rate. Interestingly, however, echocardiography detected the following significant changes: LVOT VTi variability fell by 9.15% to 13.43±3.34% (p=0.044), LVOT peak velocity variability fell by 6.64% to 12.23±1.14% (p=0.01), and IVC variability fell by 12.7% to 10.62±3.31% (p=0.03).Conclusions This study demonstrates, for the first time in a deployed military setting, that echocardiography can be used to monitor the response to volume infusion during damage control resuscitation of ventilated trauma patients. In particular, the application of Doppler and IVC parameters appeared highly sensitive to changes in volume status in this setting.


Original languageUndefined/Unknown
Pages (from-to)A71
Issue numbersuppl 2
Publication statusPublished - 2013

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Military application of mechanical CPR devices: a pressing requirement?

    Parsons, I. T., Cox, A. T. & Rees, P., Nov 2018, In : Journal of the Royal Army Medical Corps. 164, 6, p. 438-441

    Research output: Contribution to journalArticle

  2. An observational study of clinical outcomes of everolimus-eluting bioresorbable scaffolds comparing the procedural use of optical coherence tomography against angiography alone

    Hamshere, S., Byrne, A., Guttmann, O., Rees, P., Weerakody, C., Wragg, A., Knight, C., Mathur, A. & Jones, D. A., 1 Sep 2018, In : Coronary Artery Disease. 29, 6, p. 482-488

    Research output: Contribution to journalArticle

  3. Trauma Hemostasis and Oxygenation Research Network position paper on the role of hypotensive resuscitation as part of remote damage control resuscitation

    Woolley, T., Thompson, P., Kirkman, E., Reed, R., Ausset, S., Beckett, A., Bjerkvig, C., Cap, A., Coats, T., Cohen, M., Despasquale, M., Dorlac, W., Doughty, H., Dutton, R., Eastridge, B., Glassberg, E., Hudson, A., Jenkins, D., Keenan, S., Martinaud, C. & 19 others, Miles, E., Moore, E., Nordmann, G., Prat, N., Rappold, J., Reade, M. C., Rees, P., Rickard, R., Schreiber, M., Shackelford, S., Skogran Eliassen, H., Smith, J., Smith, M., Spinella, P., Strandenes, G., Ward, K., Watts, S., White, N. & Williams, S., Jun 2018, In : The Journal of Trauma Acute Care Surgery. 84, 6S, p. S3-S13

    Research output: Contribution to journalArticle

  4. REBOA at Role 2 Afloat: resuscitative endovascular balloon occlusion of the aorta as a bridge to damage control surgery in the military maritime setting

    Rees, P., Waller, B., Buckley, A. M., Doran, C., Bland, S., Scott, T. & Matthews, J., May 2018, In : Journal of the Royal Army Medical Corps. 164, 2, p. 72-76

    Research output: Contribution to journalArticle

Related by journal

  1. No association between systemic arteriosclerosis and atherosclerosis on cardiac MRI and whole body MR angiography: the TASCFORCE study

    Weir-McCall, J., Lambert, M., Belch, J., Cavin, I., Gandy, S., Littleford, R., Macfarlane, J., Matthew, S., Nicholas, R. S., Struthers, A. D., Sullivan, F., Henderson, S., White, R. & Houston, J. G., 18 May 2017, In : Heart. 103, Suppl 4, p. A5-A6 15.

    Research output: Contribution to journalAbstract

  2. Targeted Resuscitation Using Echocardiography in a Deployed Military Ebola Virus Disease Treatment Unit

    Rees, P., Jun 2015, In : Heart. p. 1 127 p., 101.

    Research output: Contribution to journalArticle

  3. 014 Atorvastatin protects human myocardium from lethal ischaemia-reperfusion injury by activating the risk pathway

    Rees, P. S. C., Babu, G. G., Boston-Griffiths, E. A., Bognolo, G., Hayward, M., Kolvekar, S., Lawrence, D., Yap, J., Hausenloy, D. J. & Yellon, D. M., 2010, In : Heart. 96, Suppl 1, p. A11

    Research output: Contribution to journalArticle

  4. BAS/BSCR45 The mitochondrial permeability transition pore as a target for cardioprotection in ventricular cardiomyocytes harvested from patients with obstructive hypertrophic cardiomyopathy

    Rees, P. S. C., Davidson, S. M., Harding, S. E., Elliot, P. M., Yellon, D. M. & Hausenloy, D. J., 2010, In : Heart. 96, 17, p. e26

    Research output: Contribution to journalArticle

ID: 244333808