51
|
Ozen C, Salcin E, Akoglu H, Onur O, Denizbasi A. Assessment of ventricular wall motion with focused echocardiography during cardiac arrest to predict survival. Turk J Emerg Med 2016; 16:12-6. [PMID: 27239632 PMCID: PMC4882209 DOI: 10.1016/j.tjem.2015.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Our primary goal is to investigate the hypothesis that in patients with a detectable ventricular wall motion (VWM) in cardiac ultrasonography (US) during cardiopulmonary resuscitation (CPR), survival rate is significantly more than in patients without VWM in US. MATERIAL AND METHODS In our prospective, single center study, 129 adult cardiac arrest (CA) patients were enrolled. Cardiac US according to Focus Assessed Transthoracic Echo (FATE) protocol was performed before CPR. Presence of VWM was recorded on forms along with demographic data, initial rhythm, CA location, presence of return of spontaneous circulation (ROSC) and time until ROSC was obtained. RESULTS 129 patients were included. ROSC was obtained in 56/77 (72.7%) patients with VWM and 3/52 (5.8%) patients without VWM which is statistically significant (p > 0.001). Presence of VWM is 95% (95% CI: 0.95-0.99) sensitive and 70% (95% CI: 0.58-0.80) specific for ROSC. 43/77 (55.8%) patients with VWM and 1 (1.9%) of 52 patients without VWM survived to hospital admission which was statistically significant (p < 0.001). Presence of VWM was 100% (95% CI: 0.87-1.00) sensitive and 54% (95% CI: 0.43-0.64) specific for survival to hospital admission. CONCLUSION No patient without VWM in US survived to hospital discharge. Only 3 had ROSC in emergency department and only 1 survived to hospital admission. This data suggests no patient without VWM before the onset of CPR survived to hospital discharge and this may be an indication to end resuscitative efforts early in these patients.
Collapse
Affiliation(s)
- Can Ozen
- Marmara University, Department of Emergency Medicine, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
52
|
O'Brien AJ, Brady RM. Point-of-care ultrasound in paediatric emergency medicine. J Paediatr Child Health 2016; 52:174-80. [PMID: 27062620 DOI: 10.1111/jpc.13098] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 12/13/2022]
Abstract
Point-of-care ultrasound (POC US) is an adjunct to clinical paediatric emergency medicine practice that is rapidly evolving, improving the outcomes of procedural techniques such as vascular access, nerve blocks and fluid aspiration and showing the potential to fast-track diagnostic streaming in a range of presenting complaints and conditions, from shock and respiratory distress to skeletal trauma. This article reviews the procedural and diagnostic uses, both established and emerging, and provides an overview of the necessary components of quality assurance during this introductory phase.
Collapse
Affiliation(s)
- Adam J O'Brien
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria
| | - Robyn M Brady
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Australia
| |
Collapse
|
53
|
Kim HB, Suh JY, Choi JH, Cho YS. Can serial focussed echocardiographic evaluation in life support (FEEL) predict resuscitation outcome or termination of resuscitation (TOR)? A pilot study. Resuscitation 2016; 101:21-6. [PMID: 26829701 DOI: 10.1016/j.resuscitation.2016.01.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/07/2016] [Accepted: 01/19/2016] [Indexed: 11/20/2022]
Abstract
AIM OF THE STUDY This study aimed to evaluate the correlation between serial echocardiography findings and return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) and to examine whether echocardiographic cardiac standstill duration can be used to predict ROSC. METHODS This was a prospective observational study of non-consecutive non-trauma adult patients with OHCA. Echocardiography was performed every 2 min during a pulse check for <10s throughout the resuscitation effort managed according to advanced life support treatment guidelines. Echocardiography findings were recorded as video clips. RESULTS Forty-eight patients were enrolled in the study. Serial echocardiographic cardiac standstill duration in the ROSC and no ROSC groups were 2.86 ± 2.07 min versus 20.30 ± 8.42 min, respectively (p<0.001). Cardiac standstill duration ≥10 min predicted non-ROSC with a sensitivity of 90.0%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 93.3%. A receiver operating characteristic curve was generated to determine the accuracy of serial echocardiographic cardiac standstill duration for predicting no ROSC. The area under the curve was 0.991 (p<0.000). CONCLUSIONS In all patients with serial echocardiographic cardiac standstill ≥10 min, no patients had ROSC. These results displayed compelling test performance and discrimination ability for subjects with and without ROSC. Our study is suggestive, and it warrants further study.
Collapse
Affiliation(s)
- Han Bit Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jun Young Suh
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jae Hyung Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
| |
Collapse
|
54
|
Bhoi S, Sinha TP, Mishra PR. Is it the time to integrate "sono cardiopulmonary resuscitation" in cardiopulmonary resuscitation algorithm of traumatic cardiac arrest? Indian J Crit Care Med 2016; 19:696-7. [PMID: 26730128 PMCID: PMC4687186 DOI: 10.4103/0972-5229.169363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sanjeev Bhoi
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Tej Prakash Sinha
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash Ranjan Mishra
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
55
|
FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Ann Surg 2015; 262:512-8; discussion 516-8. [PMID: 26258320 DOI: 10.1097/sla.0000000000001421] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the ability of Focused Assessment Using Sonography for Trauma (FAST) to discriminate between survivors and nonsurvivors undergoing resuscitative thoracotomy (RT). BACKGROUND RT is a high-risk, low-salvage procedure performed in arresting trauma patients with poorly defined indications. METHODS Patients undergoing RT from 10/2010 to 05/2014 were prospectively enrolled. A FAST examination including parasternal/subxiphoid cardiac views was performed before or concurrent with RT. The result was captured as adequate or inadequate with presence or absence of pericardial fluid and/or cardiac motion. A sensitivity analysis utilizing the primary outcome measure of survival to discharge or organ donation was performed. RESULTS Overall, 187 patients arrived in traumatic arrest and underwent FAST. Median age 31 (1-84), 84.5% male, 51.3% penetrating. Loss of vital signs occurred at the scene in 48.1%, en-route in 23.5%, and in the ED in 28.3%. Emergent left thoracotomy was performed in 77.5% and clamshell thoracotomy in 22.5%. Sustained cardiac activity was regained in 48.1%. However, overall survival was only 3.2%. An additional 1.6% progressed to organ donation. FAST was inadequate in 3.7%, 28.9% demonstrated cardiac motion and 8.6% pericardial fluid. Cardiac motion on FAST was 100% sensitive and 73.7% specific for the identification of survivors and organ donors. CONCLUSIONS With a high degree of sensitivity for the detection of potential survivors after traumatic arrest, FAST represents an effective method of separating those that do not warrant the risk and resource burden of RT from those who may survive. The likelihood of survival if pericardial fluid and cardiac motion were both absent was zero.
Collapse
|
56
|
Utility of ultrasound in resuscitation. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
57
|
Pérez-Coronado JD, Franco-Gruntorad GA. Utilidad de la ecografía en reanimación. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2015.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
58
|
Schmidt J. Fokussierte Notfallechokardiographie. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
59
|
Erratum. Acad Emerg Med 2015; 22:892. [PMID: 26171711 DOI: 10.1111/acem.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
60
|
Echocardiography for prognostication during the resuscitation of intensive care unit patients with non-shockable rhythm cardiac arrest. Resuscitation 2015; 92:1-6. [DOI: 10.1016/j.resuscitation.2015.03.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/26/2015] [Accepted: 03/29/2015] [Indexed: 12/22/2022]
|
61
|
Salam I, Hassager C, Thomsen JH, Langkjær S, Søholm H, Bro-Jeppesen J, Bang L, Holmvang L, Erlinge D, Wanscher M, Lippert FK, Køber L, Kjaergaard J. Editor’s Choice-Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction? EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:317-26. [DOI: 10.1177/2048872615585519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Idrees Salam
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Sandra Langkjær
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Helle Søholm
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lia Bang
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lene Holmvang
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Sweden
| | - Michael Wanscher
- Department of Cardiothoracic Anaesthesia 4142, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | - Lars Køber
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology 2142, Copenhagen University Hospital Rigshospitalet, Denmark
| |
Collapse
|
62
|
Limb C, Siddiqui MA. Apparent asystole: are we missing a lifesaving opportunity? BMJ Case Rep 2015; 2015:bcr-2014-208364. [PMID: 25777487 DOI: 10.1136/bcr-2014-208364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The use of ultrasonography is rapidly expanding in emergency medicine. Real-time assessment offers clues to prompt diagnosis and creates opportunities for speedy intervention. We present a case of 'cardiac monitor asystole' that proved to be ventricular fibrillation on ultrasound examination. Uniquely this case demonstrates that this, typically unrecognised, form of ventricular fibrillation responds to desynchronised defibrillation, with restoration of perfusion for approximately 30 min. With increasing access to ultrasound we believe that further research is indicated to determine whether some cases of apparent asystole may best be treated by defibrillation, presenting an opportunity to save more lives than current protocols achieve.
Collapse
|
63
|
Abstract
BACKGROUND Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. METHODS The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. RESULTS During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. CONCLUSIONS This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
Collapse
|
64
|
Soni NJ, Lucas BP. Diagnostic point-of-care ultrasound for hospitalists. J Hosp Med 2015; 10:120-4. [PMID: 25408226 DOI: 10.1002/jhm.2285] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/21/2014] [Accepted: 10/28/2014] [Indexed: 11/11/2022]
Abstract
We review the literature on diagnostic point-of-care ultrasound applications most relevant to hospital medicine and highlight gaps in the evidence base. Diagnostic point-of-care applications most relevant to hospitalists include cardiac ultrasound for left ventricular systolic function, pericardial effusion, and severe mitral regurgitation; lung ultrasound for pneumonia, pleural effusion, pneumothorax, and pulmonary edema; abdominal ultrasound for ascites, aortic aneurysm, and hydronephrosis; and venous ultrasound for central venous volume assessment and lower extremity deep venous thrombosis. Hospitalists and other frontline providers, as well as physician trainees at various levels of training, have moderate to excellent diagnostic accuracy after brief training programs for most of these applications. Despite the evidence supporting the diagnostic accuracy of point-of-care ultrasound, experimental evidence supporting its clinical use by hospitalists is limited to cardiac ultrasound.
Collapse
Affiliation(s)
- Nilam J Soni
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | | |
Collapse
|
65
|
Utility of ultrasound in resuscitation☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543040-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
66
|
Abstract
Focused cardiac echocardiography has become a critical diagnostic tool for the emergency physician and critical care physician caring for patients in shock and following trauma to the chest, and those presenting with chest pain and shortness of breath,. Cardiac echocardiography allows for immediate diagnosis of pericardial effusions and cardiac tamponade, evaluation of cardiac contractility and volume status, and detection of right ventricular strain possibly seen with a significant pulmonary embolus. This article addresses how to perform cardiac echocardiography using the standard windows, how to interpret a focused goal-directed examination, and how to apply this information clinically at the bedside.
Collapse
Affiliation(s)
- Phillips Perera
- Division of Emergency Medicine, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Alway Building M121, Stanford, CA 94305, USA.
| | | | | | | |
Collapse
|
67
|
Abstract
PURPOSE OF REVIEW Point-of-care ultrasound (POCUS) has become an integral part of emergency medicine practice. Research evaluating POCUS in the care of pediatric patients has improved the understanding of its potential role in clinical care. RECENT FINDINGS Recent work has investigated the ability of pediatric emergency medicine (PEM) physicians to perform a wide array of diagnostic and procedural applications in POCUS ultrasound. Studies have demonstrated that PEM providers are able to identify an array of diseases, including intussusception, pyloric stenosis and appendicitis. Novel applications of ultrasound, such as a cardiac evaluation in the acutely ill patient or identification of skull fractures in the assessment of a patient with head injury, have shown excellent promise in recent studies. These novel applications have the potential to reshape pediatric diagnostic algorithms. SUMMARY Key applications in PEM have been investigated in the recent publications. Further exploration of the ability to integrate ultrasound into routine practice will require larger-scale studies and continued growth of education in the field. The use of ultrasound in clinical practice has the potential to improve safety and efficiency of care in the pediatric emergency department.
Collapse
|
68
|
Adhikari S, Fiorello A, Stolz L, Jones T, Amini R, Gross A, O'Brien K, Mosier J, Blaivas M. Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities. Am J Emerg Med 2013; 32:363-6. [PMID: 24428984 DOI: 10.1016/j.ajem.2013.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To determine the ability of emergency physicians to detect complex abnormalities on point-of-care (POC) echocardiograms. METHODS Single-blinded, nonrandomized, cross-sectional study. Twenty-five different emergency medicine clinical scenarios (video clips and digital images) covering a variety of echocardiographic abnormalities were presented to a group of emergency physician sonologists. The echocardiographic abnormalities included right ventricular dysfunction, left ventricular systolic dysfunction, diastolic dysfunction, regional wall motion abnormalities, Doppler abnormalities of pericardial tamponade physiology, left ventricular hypertrophy, hypertrophic cardiomyopathy, and aortic abnormalities. All emergency physician sonologists were blinded to the study hypothesis. They reviewed echocardiography video clips and images individually, and their interpretations were compared with the criterion standard (expert echocardiographer interpretations). RESULTS A total of 200 echocardiography studies (video clips and images) were independently reviewed by 8 emergency physician sonologists with varying POC echocardiography experiences. Emergency physicians accurately identified left ventricular systolic dysfunction 94% of the time, diastolic dysfunction (100%), and right ventricular dysfunction 80% of the time. Regional wall motion abnormalities were detected only 50% of the time. Doppler echocardiographic abnormalities of pericardial tamponade physiology were accurately identified 57% of the time. Emergency physicians who performed more than 250 POC echocardiograms were found to be more accurate in identifying complex echocardiographic abnormalities. CONCLUSIONS Our study results suggest that with increased experience, emergency physicians can accurately identify most of complex echocardiographic abnormalities.
Collapse
Affiliation(s)
- Srikar Adhikari
- Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ.
| | - Albert Fiorello
- Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ
| | - Lori Stolz
- Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ
| | - Travis Jones
- Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ
| | - Richard Amini
- Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ
| | - Austin Gross
- Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ
| | - Kathleen O'Brien
- Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ
| | - Jarrod Mosier
- Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ
| | - Michael Blaivas
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC
| |
Collapse
|
69
|
Prehospital emergency ultrasound: a review of current clinical applications, challenges, and future implications. Emerg Med Int 2013; 2013:531674. [PMID: 24171113 PMCID: PMC3792527 DOI: 10.1155/2013/531674] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 08/22/2013] [Indexed: 12/19/2022] Open
Abstract
Imaging modalities in the prehospital setting are helpful in the evaluation and management of time-sensitive emergency conditions. Ultrasound is the main modality that has been applied by emergency medical services (EMS) providers in the field. This paper examines the clinical applications of ultrasound in the prehospital setting. Specific focus is on applications that provide essential information to guide triage and management of critical patients. Challenges of this modality are also described in terms of cost impact on EMS agencies, provider training, and skill maintenance in addition to challenges related to the technical aspect of ultrasound.
Collapse
|