e²FAST - Integrating Inferior Vena Cava Ultrasound Into the Extended Focused Assessment With Sonography for Trauma as a Rapid Diagnostic Tool of Hemorrhagic Shock in Trauma Patients

Q: What is the e²FAST protocol and how does it relate to eFAST?

e²FAST integrates inferior vena cava ultrasound (IVCUS) into the existing extended focused assessment with sonography for trauma (eFAST). The goal is to enhance early detection of hypovolemia and guide resuscitation in trauma patients.

Q: Which ultrasound measures of the inferior vena cava are evaluated in this review?

The review includes studies assessing IVC diameter and the IVC collapsibility index (IVC-CI). These measures are used to determine volume status, shock, or fluid responsiveness.

Q: What diagnostic or prognostic performance outcomes are reported for IVC ultrasound?

IVC ultrasound is reported to show sensitivity and specificity for detecting hypovolemia, and IVC diameter and IVC-CI thresholds are associated with ICU admission, transfusion needs, emergency surgery requirements, mortality, and fluid responsiveness after resuscitation.

Sep 29, 2026

Uploaded by WPS_1790064749

Hemorrhagic shock drives preventable trauma mortality, requiring rapid, accurate bedside diagnosis. This narrative review evaluates whether integrating inferior vena cava ultrasound (IVCUS) into the extended focused assessment with sonography for trauma (eFAST)—the “e²FAST” protocol—improves early shock detection and supports fluid resuscitation. Studies from 2000 to January 2025 across major databases were screened; 13 eligible studies were qualitatively reviewed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Introduction And Background

Review

Methodology

How to cite this article

Study Design

Review began 10/02/2025 Review ended 11/30/2025 Published 12/05/2025 © Copyright 2025 Alsalmi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98529 Open Access Review Article e²FAST: Integrating Inferior Vena Cava Ultrasound Into the Extended Focused Assessment With Sonography for Trauma as a Rapid Diagnostic Tool of Hemorrhagic Shock in Trauma Patients Fawziah Alsalmi 1 , Joe Nemeth 2 , Mahmood Alshaaban 3 1. Emergency Medicine, King Fahad Armed Forces Hospital, Jeddah, SAU 2. Emergency Medicine/Trauma, McGill University, Montreal, CAN 3. Emergency Medicine/Trauma, King Hamad University Hospital, Muharraq, BHR Corresponding author: Fawziah Alsalmi, [f.r.alsalmi42@gmail.com](f.r.alsalmi42@gmail.com) Abstract Hemorrhagic shock remains a leading cause of preventable trauma-related deaths, highlighting the need for rapid and accurate diagnosis. This study evaluates whether integrating inferior vena cava ultrasound (IVCUS) into the extended focused assessment with Sonography for trauma (eFAST), referred to as “e²FAST,”improves early shock detection and guides fluid resuscitation in trauma patients. A comprehensive narrative review was conducted to assess the diagnostic and prognostic value of IVC-US as a rapid diagnostic tool for hemorrhagic shock in trauma patients. Studies published from 2000 to January 2025 were searched across PubMed, MEDLINE, EMBASE, Cochrane Library, and Scopus databases. Studies were included if they involved adult trauma patients and evaluated IVC diameter or the collapsibility index (IVC-CI) to determine volume status, shock, or fluid responsiveness. Two independent reviewers screened and selected studies based on predefined inclusion criteria. In total, 13 eligible studies, including randomized controlled trials, prospective and retrospective cohorts, and cross-sectional analyses, were reviewed qualitatively. Key outcomes extracted included diagnostic accuracy, fluid responsiveness, transfusion requirements, intensive care unit (ICU) admission, and mortality. IVC-US demonstrated a sensitivity of 71% and specificity of 75% in detecting hypovolemia. A smaller IVC diameter (<1 .5 cm) was significantly associated with increased ICU admissions (51 .3%), higher transfusion rates (12 .2%), increased emergency surgery requirements (16 .2%), and elevated mortality (13 .5%) . Additionally, an IVC-CI greater than 38.5% provided 80% sensitivity and 85. 7% specificity for predicting fluid responsiveness in patients with major blunt trauma. Post-resuscitation assessments (IVC-CI ≤28 .6%) were predictive of fluid unresponsiveness (80% sensitivity, 75% specificity) . Moreover, IVC-US reliably predicted 24-hour fluid requirements, helping in real-time fluid management. Integrating IVC-US into the eFAST as the e²FAST protocol enhances diagnostic accuracy for identifying hemorrhagic shock and provides critical real-time guidance for fluid resuscitation. Given its non-invasive nature, reliability, and predictive value for patient outcomes, standardized inclusion of IVC measurements in trauma protocols is recommended. Future research should prioritize multicenter randomized trials and standardized operator training to minimize variability and support broad clinical implementation. Categories: Radiology, Emergency Medicine, Trauma Keywords: e-fast, efast protocol, emergency medicine, focused assessment with sonography in trauma (fast), hemorrhagic shock, inferior vena cava ultrasound (ivc-us), massive hemorrhage protocol, point-of-care ultrasound (pocus), resuscitation, trauma Introduction And Background Hemorrhagic shock remains a leading cause of preventable death in trauma patients, necessitating early detection and prompt intervention [1] . While the focused assess

FAQs

What is the e²FAST protocol and how does it relate to eFAST?

e²FAST integrates inferior vena cava ultrasound (IVCUS) into the existing extended focused assessment with sonography for trauma (eFAST). The goal is to enhance early detection of hypovolemia and guide resuscitation in trauma patients.

Which ultrasound measures of the inferior vena cava are evaluated in this review?

The review includes studies assessing IVC diameter and the IVC collapsibility index (IVC-CI). These measures are used to determine volume status, shock, or fluid responsiveness.

What diagnostic or prognostic performance outcomes are reported for IVC ultrasound?

IVC ultrasound is reported to show sensitivity and specificity for detecting hypovolemia, and IVC diameter and IVC-CI thresholds are associated with ICU admission, transfusion needs, emergency surgery requirements, mortality, and fluid responsiveness after resuscitation.

Sep 29, 2026

Uploaded by WPS_1790064749