Feasibility of FAST examination performance with ultrasound contrast

The Focused Abdominal Sonography in Trauma (FAST) examination has several limitations, among which is the inability to reliably detect solid organ injury. We sought to evaluate the feasibility of ultrasound contrast use during a FAST examination and its effect on the ability to delineate vasculature in the spleen and liver from hilum to capsule on simulated patients. This prospective observational case control study was conducted at an urban community hospital Emergency Department (ED) that is a level I trauma facility. During a FAST examination, the liver and spleen were scanned in entirety to evaluate contrast opacification of blood vessels and a latent phase highlighting the parenchyma of the liver and spleen. Each physician, hospital credentialed for the use of emergency ultrasound, scanned the liver and spleen both before and after contrast administration. Five milliliters of contrast were mixed with 16 mL of normal saline and then injected 4 mL at a time through an 18-gauge anticubital catheter. All examinations were successfully completed before contrast agent dissipation. The mean time to complete the FAST examination with interrogation of the liver and spleen was 1 min 42 s (range 1 min 22 s to 2 min 5 s). The mean time to initial visualization of contrast was 15 s (range 12 to 18 s). The latent phase of the ultrasound contrast when the liver or spleen began to shimmer, an effect that would outline hematomas not actively bleeding, occurred at a mean time of 54 s (range 45 s to 1 min 9 s). The ultrasound contrast disappeared at a mean of 2 min 52 s (range of 2 min 16 s to 3 min 33 s). In conclusion, ultrasound contrast use is feasible during the FAST examination and allows enhanced evaluation of solid organ parenchyma during evaluation for solid organ injury.