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Research Snapshot Theater: Resuscitation, Adult and Pediatric and Veterinarian

Point-of-Care Ultrasound: An Indispensable Tool in Massive Hemorrhage Resuscitation in Three Cases

Monday, March 23, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 17

Gilbert V. Andry, N/A (he/him/his)

Louisiana

Disclosure(s): No relevant financial relationship(s) to disclose.
TB

Terence Byrne, N/A

N/A
N/A

Disclosure information not submitted.
SB

Sean Bloos, MD

Anesthesiology Resident
Vanderbuilt

Disclosure information not submitted.
DR

David Rayburn, MD, MPH

Pediatric Emergency Medicine
LCMC Health

Disclosure information not submitted.
Celestino Castanon, MD (he/him/his)

Louisiana

Disclosure(s): No relevant financial relationship(s) to disclose.
JH

John Helmstetter, MD

Associate Professor of Clinical Anesthesiology
LSU Health Science Center, School of Medicine

Disclosure information not submitted.
RP

Richard Pino, MD, PhD, FCCM

Professor of Anesthesiology and Department Head
LSU Health Science Center, School of Medicine

Disclosure information not submitted.
JR

James Riopelle, MD

Professor of Clinical Anesthesiology
LSU Health Science Center, School of Medicine

Disclosure information not submitted.
AS

Alison Smith, MD, PhD, FACS

Trauma Medical Director, McSwain Level 1 Trauma Center
Louisiana State University Health Sciences Center

Disclosure information not submitted.
JS

Jonathan Schoen, MD, MPH, FACS

Clinical Associate Professor of Surgery
LSU Health Science Center, School of Medicine

Disclosure information not submitted.
AM

Alan Marr, MD, FACS

General Surgeon
LSU Health Science Center, School of Medicine

Disclosure information not submitted.
LS

Lance Stuke, MD, MPH, FACS

Professor of Clinical Surgery
LSU Health Science Center, School of Medicine

Disclosure information not submitted.
John Hunt, MS,

New Jersey

Disclosure information not submitted.
PG

Patrick Greiffenstein, MD, FACS

Trauma Intensive Care Unit Medical Director at LSU Health Sciences Center
Louisiana State University Health Sciences Center

Disclosure information not submitted.

Introduction: Cardiac ultrasonography has been suggested as an adjunct tool in the early assessment of pulseless trauma victims to aid in prognosis. Several studies show that patients with an organized cardiac rhythm on ultrasound despite pulselessness have a higher probability of survival, yet the value of cardiac serial functional assessment with point of care ultrasonography (POCUS) in ongoing trauma resuscitation has not been described.

Methods: This study aims to demonstrate the practical use of serial POCUS assessments, in the setting of trauma resuscitation. We describe three cases where patient care was affected using POCUS.

Results: The first case is of a 27 year old male who sustained a stab wound to the left upper extremity. The patient was brought in by EMS after a witnessed traumatic arrest in the field where CPR had been performed for >30 minutes. On arrival to the hospital POCUS showed organized cardiac activity with an ejection fraction >80%. This prompted further care, when cessation of resuscitation efforts could have been justified under contemporary NAESMP guidelines.
In another case, a 32 year old male presenting with penetrating trauma, POCUS was used intraoperatively when the patient became profoundly hypotensive (SBP < 60) with no palpable carotid pulse. POCUS showed organized cardiac activity with an ejection fraction of >80%. Chest compressions were withheld because of this US finding and MTP was resumed with a rapid blood transfuser until hemostasis could be achieved operatively.
The last case is a 29 year old male presenting with penetrating trauma to the left hip. Multiple transfusions were administered and the patient was taken to the operating room. Despite multiple transfusions the patient became profoundly hypotensive in the operative room (SBP < 90). Intraoperative POCUS revealed transfusion associated cardiovascular overload, prompting transfusion cessation, increasing norepinephrine dosing, and initiating vasopressin with hemodynamic improvement.

Conclusions: This case series demonstrates the feasibility of using POCUS to guide resuscitation. It highlights the need to revisit current guidelines of traumatic cardiac arrest and revise the approach to pulseless hypovolemia with early and ongoing assessment of resuscitation with POCUS.