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West DA, Killick C, Jones D. Use of point-of-care ultrasound during cardiac arrest in the intensive care unit: A cross-sectional survey. Aust Crit Care 2024:S1036-7314(24)00082-1. [PMID: 38797583 DOI: 10.1016/j.aucc.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND There is growing interest in the use of point-of-care ultrasound during cardiac arrest, but few studies document its use in the intensive care unit. OBJECTIVE We hypothesised this may reflect a low prevalence of use of point-of-care ultrasound during cardiac arrest or negative attitudes towards its use. We aimed to determine the self-reported prevalence, attitudes towards, and barriers to use of point-of-care ultrasound during cardiac arrest in the intensive care unit. METHODS We conducted a web-based survey over 3 months (08/08/2022-06/11/2022), of intensive care unit consultants and registrars in Victoria, Australia. Descriptive and mixed-methods analyses of Likert-type and free-text answers were performed. RESULTS The response rate was 91/398 (22.8%), split evenly between consultants and registrars. There was a broad range of clinical and ultrasound experience. Only 22.4% (22/91) of respondents reported using point-of-care ultrasound 75-100% of the time during their management of cardiac arrest. Respondents rated the value they place in point-of-care ultrasound during cardiac arrest 3 (interquartile range: 3-4) and that of a "skilled operator" 4 ((interquartile range; 4-5) on a 5-point scale. Free-text analysis suggested exclusion of "tamponade" (40/80 [50%] comments) as the most valuable use-case and "skill" as a personal barrier (20/73 [27.4%] comments). Personal and departmental barriers were not rated highly, although registrars perceived "lack of a structured training program" as a barrier. Respondents were equivocal in the value they gave point-of-care ultrasound during cardiac arrest but saw greater value when conducted by a skilled operator. CONCLUSIONS Point-of-care ultrasound was reported to be infrequently used in cardiac arrest, mostly due to self-perceived skill and lack of a structured training program.
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Affiliation(s)
- David A West
- Intensive Care Unit, Monash Hospital, Clayton, VIC, Australia.
| | - Caroline Killick
- Intensive Care Unit, Monash Hospital, Clayton, VIC, Australia; Department of Paediatrics, Monash University, VIC, Australia
| | - Daryl Jones
- Intensive Care Unit, Austin Hospital, Heidelberg, VIC, Australia; Department of Surgery and Department of Intensive Care, University of Melbourne, Parkville, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
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Boivin Z, Xu C, Doko D, Herbst MK, She T. Prevalence of Phantom Scanning in Cardiac Arrest and Trauma Resuscitations: The Scary Truth. POCUS JOURNAL 2023; 8:217-222. [PMID: 38099175 PMCID: PMC10721300 DOI: 10.24908/pocus.v8i2.16690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Background: The prevalence of phantom scanning, or point of care ultrasound (POCUS) performed without saving images, has not been well studied. Phantom scanning can negatively affect patient care, reduce billed revenue, and can increase medicolegal liability. We sought to quantify and compare the prevalence of phantom scanning among emergency department (ED) cardiac arrests and trauma resuscitations. Methods: This was a single center, retrospective cohort study from July 1, 2019, to July 1, 2021, of all occurrences of POCUS examination documented on the resuscitation run sheet during cardiac arrest and trauma resuscitations. Two investigators reviewed the run sheets to screen for POCUS documentation. Instances where documentation was present were matched with saved images in the picture archiving and communication system. Instances where documentation was present but no images could be located were considered phantom scans. A two-tailed student's t test was utilized to compare the phantom scanning rate between cardiac arrest and trauma resuscitations. Results: A total of 1,862 patients were included in the study period, with 329 cardiac arrests and 401 trauma resuscitations having run sheet documentation of POCUS performance. The phantom scanning rate in cardiac arrests and trauma resuscitations was 70.5% (232/329) and 86.5% (347/401), respectively (p < 0.001). Conclusion: Phantom scanning is common in both cardiac arrests and trauma resuscitations in the ED at our institution, but is significantly higher in trauma resuscitations. Further research is needed to assess causes and develop potential solutions to reduce the high prevalence of phantom scanning.
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Affiliation(s)
- Zachary Boivin
- University of Connecticut Emergency Medicine Residency, University of Connecticut School of MedicineFarmington, CTUSA
| | - Curtis Xu
- University of Connecticut Emergency Medicine Residency, University of Connecticut School of MedicineFarmington, CTUSA
| | - Donias Doko
- University of Connecticut Emergency Medicine Residency, University of Connecticut School of MedicineFarmington, CTUSA
| | - Meghan Kelly Herbst
- Department of Emergency Medicine, University of Connecticut School of MedicineFarmington, CTUSA
| | - Trent She
- Department of Emergency Medicine, Hartford HospitalHartford, CTUSA
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3
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Patrick DP, Bradley XG, Wolek C, Anderson B, Grady J, Herbst MK. Minutes matter: Time it takes to perform point-of-care ultrasound. AEM EDUCATION AND TRAINING 2023; 7:e10901. [PMID: 37600853 PMCID: PMC10436032 DOI: 10.1002/aet2.10901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
Background While point-of-care ultrasound (PoCUS) is a safe, versatile tool that can improve patient care, the perceived time investment needed to incorporate PoCUS into clinical care is cited as a barrier to performance. We sought to determine the time it takes to perform a PoCUS examination and whether this time was influenced by training level and prior ultrasound experience. Methods This was a retrospective study looking at time stamps of all emergency medicine (EM) provider-performed PoCUS examinations during clinical shifts from August 10, 2019, to June 7, 2022, at a suburban academic emergency department that is the site for a 3-year EM residency. Our workflow is order-based; when PoCUS is ordered, that patient's information populates the ultrasound machine worklist. Selecting the patient's name from the worklist generates a time-stamped patient information page (PIP). We defined the PIP time stamp as the start of the PoCUS examination. The duration of one PoCUS examination was defined as the time of the last image acquired minus the time of the PIP. General estimating equations were used to estimate differences between training level and between prior scan status using an exchangeable correlation and Tukey adjusted pairwise comparisons. A two-tailed chi-square analysis was used for comparing accuracy according to training level. Results Of 4187 PoCUS examinations abstracted, 2144 met study criteria. The median (IQR) time spent per examination was 6.0 (3-9) min. First-year residents took the longest to perform PoCUS among all providers (p < 0.0001). Residents with fewer than 250 prior scans took longer than residents with 501-800 (p = 0.0002) and >800 (p = 0.0013). Resident accuracy was not significantly different according to training level. Conclusions Overall median time to perform PoCUS was 6.0 min. EM residents became more efficient in performing PoCUS as they advanced from first- to third-year, without compromising accuracy.
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Affiliation(s)
| | - Xenia Gia Bradley
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Caroline Wolek
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Bowen Anderson
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - James Grady
- Department of Public Health SciencesUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Meghan Kelly Herbst
- Department of Emergency MedicineUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
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4
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Smith M, Krishnan SV, Leamon A, Galwankar S, Sinha TP, Kumar VA, Laere JV, Gallien J, Bhoi S. Removing Barriers to Emergency Medicine Point-of-Care Ultrasound: Illustrated by a Roadmap for Emergency Medicine Point-of-Care Ultrasound Expansion in India. J Emerg Trauma Shock 2023; 16:116-126. [PMID: 38025509 PMCID: PMC10661575 DOI: 10.4103/jets.jets_50_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 12/01/2023] Open
Abstract
Point-of-care ultrasound (PoCUS) has a potentially vital role to play in emergency medicine (EM), whether it be in high-, medium-, or low-resourced settings. However, numerous barriers are present which impede EM PoCUS implementation nationally and globally: (i) lack of a national practice guideline or scope of practice for EM PoCUS, (ii) resistance from non-PoCUS users of ultrasound imaging (USI) and lack of awareness from those who undertake parallel or post-EM patient care, and (iii) heterogeneous pattern of resources available in different institutes and settings. When combined with the Indian Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, this has led to the majority of India's 1.4 billion citizens being unable to access EM PoCUS. In order to address these barriers (globally as well as with specific application to India), this article outlines the three core principles of EM PoCUS: (i) the remit of the EM PoCUS USI must be well defined a priori, (ii) the standard of EM PoCUS USI must be the same as that of non-PoCUS users of USI, and (iii) the imaging performed should align with subsequent clinical decision-making and resource availability. These principles are contextualized using an integrated PoCUS framework approach which is designed to provide a robust foundation for consolidation and expansion across different PoCUS specialisms and health-care settings. Thus, a range of mechanisms (from optimization of clinical practice through to PoCUS educational reform) are presented to address such barriers. For India, these are combined with specific mechanisms to address the PCPNDT Act, to provide the basis for influencing national legislation and instigating an addendum to the Act. By mapping to the recent Lancet Commission publication on transforming access to diagnostics, this provides a global and cross-discipline perspective for the recommendations.
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Affiliation(s)
- Mike Smith
- School of Health Sciences, Cardiff University, Cardiff, Wales, UK
| | - S. Vimal Krishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | - Andrew Leamon
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Sagar Galwankar
- Department of Emergency Medicine, Florida State University, Tallahassee, Florida, USA
| | - Tej Prakash Sinha
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijaya Arun Kumar
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jeffrey V. Laere
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - John Gallien
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Resop DM, Basrai Z, Boyd JS, Williams JP, Nathanson R, Mader MJ, Haro EK, Drum B, O'Brien E, Khosla R, Bales B, Wetherbee E, Sauthoff H, Schott CK, Soni NJ. Current use, training, and barriers in point-of-care ultrasound in emergency departments in 2020: A National Survey of VA hospitals. Am J Emerg Med 2023; 63:142-146. [PMID: 36182580 DOI: 10.1016/j.ajem.2022.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dana M Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA; Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Jeremy S Boyd
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN, USA; VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, TN, USA.
| | - Jason P Williams
- Atlanta VA Medical Center, Medicine Service, Atlanta, GA, USA; Emory School of Medicine, Division of Hospital Medicine, Atlanta, GA, USA.
| | - Robert Nathanson
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA.
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX, USA.
| | - Elizabeth K Haro
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA.
| | - Brandy Drum
- Healthcare Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA.
| | - Edward O'Brien
- Healthcare Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA.
| | - Rahul Khosla
- Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC, USA; Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC, USA.
| | - Brian Bales
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN, USA; VA Tennessee Valley Healthcare System-Nashville, Department of Emergency Medicine, Nashville, TN, USA.
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, NY, New York, USA.
| | - Christopher K Schott
- VA Pittsburgh Health Care Systems, Critical Care Service, Pittsburgh, PA, USA; University of Pittsburgh, Departments of Critical Care Medicine and Emergency Medicine, Pittsburgh, PA, USA.
| | - Nilam J Soni
- South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Hospital Medicine, San Antonio, TX, USA; University of Texas Health San Antonio, Division of Pulmonary Diseases & Critical Care Medicine, San Antonio, TX, USA.
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6
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Heinz ER, Vincent A. Point-of-Care Ultrasound for the Trauma Anesthesiologist. CURRENT ANESTHESIOLOGY REPORTS 2022; 12:217-225. [PMID: 35075351 PMCID: PMC8771171 DOI: 10.1007/s40140-021-00513-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 01/03/2023]
Abstract
Purpose of Review With advances in technology and availability of handheld ultrasound probes, studies are focusing on the perioperative care of patients, but a limited number specifically on trauma patients. This review highlights recent findings from studies using point of care ultrasound (POCUS) to improve the care of trauma patients. Recent Findings Major findings include the use of POCUS to assess volume status of trauma patients upon arrival to measure the major vasculature. Additionally, several studies have advanced the use of POCUS to identify pneumothorax in trauma patients. Finally, the ASA POCUS certification and ASRA expert guidelines are examples of international organizations establishing guidelines for utilization and training of anesthesiologists in the field of POCUS, which will be discussed. Summary Despite the COVID-19 pandemic, and considerable resources being diverted to fight this global healthcare crisis, advances are being made in utilization of POCUS to aid the care of trauma patients.
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Affiliation(s)
- Eric R. Heinz
- Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Faculty Associates, 2300 M Street NW, 7thFloor, Washington, DC 20037 USA
| | - Anita Vincent
- Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Faculty Associates, 2300 M Street NW, 7thFloor, Washington, DC 20037 USA
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7
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Yang FM, Ma BZ, Liu Y, Sun Q, Li N, Feng SY, Wang WJ. Lung Ultrasound for Detecting Tracheal and Mainstem Intubation: A Systematic Review and Meta-Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:3-9. [PMID: 34706844 DOI: 10.1016/j.ultrasmedbio.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Precise positioning of the left or right main bronchus is a prerequisite for effective lung isolation in thoracic surgeries. This study aimed to clarify the ability of lung ultrasound to detect tracheal and mainstem intubation. Studies that investigated the ability of lung ultrasound to detect tracheal and mainstem intubation were searched from PubMed and ScienceDirect databases from their inception to March 2021. The pooled accuracy of this method and its sensitivity and specificity were computed with a fixed-effects model using Stata 14.0. Nine eligible articles that involved a total of 617 participants were included in this systematic review and meta-analysis. Overall, the accuracy of lung ultrasound in detecting tracheal and mainstem intubation was 86.7%, with a sensitivity of 93.0% and a specificity of 75.0%. Subgroup analysis revealed that the accuracy remained high regardless of patient age, ultrasonic method, sample size, study design or ultrasonic skills training. Sensitivity analysis indicated that the results were stable. Deeks' test showed no publication bias. These findings imply that lung ultrasound is an effective method for detecting tracheal and mainstem intubation.
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Affiliation(s)
- Feng Mei Yang
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Bao Zhong Ma
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Ying Liu
- Anesthesiology Department, Cangzhou People's Hospital, Cangzhou City, China
| | - Qiang Sun
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Nan Li
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Shun Yi Feng
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China
| | - Wen Jie Wang
- Emergency Department, Cangzhou Central Hospital, Cangzhou City, China;.
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Wu M, Awasthi N, Rad NM, Pluim JPW, Lopata RGP. Advanced Ultrasound and Photoacoustic Imaging in Cardiology. SENSORS (BASEL, SWITZERLAND) 2021; 21:7947. [PMID: 34883951 PMCID: PMC8659598 DOI: 10.3390/s21237947] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/26/2022]
Abstract
Cardiovascular diseases (CVDs) remain the leading cause of death worldwide. An effective management and treatment of CVDs highly relies on accurate diagnosis of the disease. As the most common imaging technique for clinical diagnosis of the CVDs, US imaging has been intensively explored. Especially with the introduction of deep learning (DL) techniques, US imaging has advanced tremendously in recent years. Photoacoustic imaging (PAI) is one of the most promising new imaging methods in addition to the existing clinical imaging methods. It can characterize different tissue compositions based on optical absorption contrast and thus can assess the functionality of the tissue. This paper reviews some major technological developments in both US (combined with deep learning techniques) and PA imaging in the application of diagnosis of CVDs.
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Affiliation(s)
- Min Wu
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands; (N.M.R.); (R.G.P.L.)
| | - Navchetan Awasthi
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands; (N.M.R.); (R.G.P.L.)
- Medical Image Analysis Group (IMAG/e), Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands;
| | - Nastaran Mohammadian Rad
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands; (N.M.R.); (R.G.P.L.)
- Medical Image Analysis Group (IMAG/e), Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands;
| | - Josien P. W. Pluim
- Medical Image Analysis Group (IMAG/e), Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands;
| | - Richard G. P. Lopata
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands; (N.M.R.); (R.G.P.L.)
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