Detection and Management of Non‐Compressible Hemorrhage by Vena Cava Ultrasonography



Status:Completed
Conditions:Hospital
Therapuetic Areas:Other
Healthy:No
Age Range:18 - Any
Updated:7/13/2018
Start Date:August 2012
End Date:March 1, 2018

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This is a study of patients admitted with major traumatic injuries. Such patients may develop
inadequate circulation to the organs as a result of internal blood loss. Early detection of
internal blood loss can be difficult as physical examination alone may miss patients with
significant blood loss. Some patients with internal bleeding will arrive with low blood
pressure; these patients are usually given 2 liters of intravenous fluid to determine if
their blood pressure will recover. If the blood pressure does not rise or if it drops again
later, the blood loss can be assumed to be severe, and the patient will likely need
transfusions, surgery and other interventions. However, this fluid treatment method can lead
to delays and complications as some patients may initially respond but then continue to
bleed. The inferior vena cava (IVC) is the large vein draining blood from the lower body to
the heart. The inferior vena cava is known to empty when the patient has had significant
blood loss. The vena cava diameter can be seen using ultrasound. This study intends to
perform ultrasound to examine the vena cava diameter on patients just after arriving with
major trauma. The hypothesis of the proposed study is that an ultrasound assessment protocol
of inferior vena cava diameter and collapsibility can detect and aid management of
non-compressible hemorrhage in major trauma victims. After the patient has been given the 2
liter intravenous fluid treatment, the inferior vena cava diameter will be measured again. A
third examination 8-24 hours after admission will determine if the inferior vena cava
diameter has returned to normal. We propose that measuring the inferior vena cava in this
manner can predict those patients who are likely to continue bleeding and require
interventions such as surgery. Early detection in these patients may avoid delays in
treatment, complications and excess mortality. Because this examination is done with handheld
ultrasound machines, it could be done outside hospitals and in military combat casualty care.


Inclusion Criteria:

- Major trauma patients brought to Level I Trauma Centers.

- Selected patients for the study will be those presenting with IVC collapsibility > 50%
on modified-FAST at admission and/or

- IVC diameter of < 12mm on modified FAST at admission and/or

- A non-visualized IVC due to total collapse on modified FAST at admission (not due to
body habitus or inadequate ultrasonography technique)

Exclusion Criteria:

- Pregnancy after 20 weeks gestation

- Those under 18 years of age

- Prisoners and others prohibited from participating in clinical trials

- Patients with severe traumatic brain injury who at admission are deemed by treating
surgeons as having non-survivable brain injuries
We found this trial at
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201 Dowman Dr
Atlanta, Georgia 30303
(404) 727-6123
Emory University Emory University, recognized internationally for its outstanding liberal artscolleges, graduate and professional schools,...
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201 Presidents Circle
Salt Lake City, Utah 84108
801) 581-7200
University of Utah Research is a major component in the life of the U benefiting...
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Baltimore, Maryland 21201
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Richmond, Virginia 23298
(804) 828-0100
Phone: 804-827-1207
Virginia Commonwealth University Since our founding as a medical school in 1838, Virginia Commonwealth University...
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San Diego, California 92103
Principal Investigator: Jay J Doucet, MD
Phone: 619-543-7200
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