1
|
Leviter JI, Feick M, Riera A, White LJ. A Protocol for Using Point-of-Care Ultrasound as an Adjunct in Pediatric Cardiac Arrest: Pediatric Ultrasound for Life-Supporting Efforts. Pediatr Emerg Care 2024:00006565-990000000-00493. [PMID: 39043130 DOI: 10.1097/pec.0000000000003239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
ABSTRACT Pediatric cardiac arrest is a rare but time-critical event that poses significant challenges to health care providers. Initiation of point-of-care ultrasound (POCUS) early in resuscitation can help optimize the location of chest compressions, identify inadequate compressions, evaluate for sonographic pulse, and help direct management. Although several algorithms currently exist to incorporate POCUS into adult cardiac arrest, none, to our knowledge, currently exist for the pediatric population. We propose a novel protocol for POCUS use as an adjunct to existing standard-of-care measures in pediatric cardiac arrest, which we call the Pediatric Ultrasound for Life-Supporting Efforts protocol.
Collapse
Affiliation(s)
- Julie I Leviter
- From the Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | | | | | - Lauren J White
- Pediatric Critical Care Medicine, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
2
|
Hill MA, Jones JD, Mand SK, Tschautscher C, Cathers AD, Kuttab HI. Prehospital Cardiac Ultrasound to Confirm Mechanical Capture in Emergency Transcutaneous Pacing: A Case Report. Air Med J 2024; 43:357-359. [PMID: 38897701 DOI: 10.1016/j.amj.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 06/21/2024]
Abstract
Point-of-care ultrasound (POCUS) is a safe diagnostic tool that clinicians use to rapidly evaluate critically ill patients.1 POCUS has expanded into the prehospital setting and has been demonstrated to be accurate, feasible, and helpful in guiding clinical decision making.2-4 Additionally, the American College of Emergency Physicians recommends the use of echocardiography to evaluate for ventricular activity in the setting of cardiac arrest.5 There is minimal evidence regarding the use of POCUS to confirm mechanical capture in patients undergoing transcutaneous pacing. This case report highlights the use of POCUS in a patient with bradyasystolic cardiac arrest requiring transcutaneous pacing. Despite electrical capture, the patient had absent central pulses; however, POCUS demonstrated ventricular contractions, indicating mechanical capture. This suggests a role for POCUS for the evaluation of mechanical capture in patients undergoing cardiac pacing.
Collapse
Affiliation(s)
- Mason A Hill
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
| | - Jarett D Jones
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
| | - Simanjit K Mand
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
| | - Craig Tschautscher
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI; Med Flight, University of Wisconsin-Madison Hospitals and Clinics, Madison, WI
| | - Andrew D Cathers
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI; Med Flight, University of Wisconsin-Madison Hospitals and Clinics, Madison, WI
| | - Hani I Kuttab
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI; Med Flight, University of Wisconsin-Madison Hospitals and Clinics, Madison, WI.
| |
Collapse
|
3
|
Sonmez E, Taslidere B, Ozkan A. A new method of pulse control in cardiopulmonary resuscitation; Continuous femoral pulse check. Am J Emerg Med 2024; 80:168-173. [PMID: 38613985 DOI: 10.1016/j.ajem.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES The reliability of manual pulse checks has been questioned but is still recommended in cardiopulmonary resuscitation (CPR) guidelines. The aim is to compare the 10-s carotid pulse check (CPC) between heart massage cycles with the continuous femoral pulse check (CoFe PuC) in CPR, and to propose a better location to shorten the interruption times for pulse check. METHODS A prospective study was conducted on 117 Non-traumatic CPR patients between January 2020 and January 2022. A total of 702 dependent pulse measurements were executed, where carotid and femoral pulses were simultaneously assessed. Cardiac ultrasound, end-tidal CO2, saturation, respiration, and blood pressure were employed for pulse validation. RESULTS The decision time for determining the presence of a pulse in the last cycle of CPR was 3.03 ± 1.26 s for CoFe PuC, significantly shorter than the 10.31 ± 5.24 s for CPC. CoFe PuC predicted the absence of pulse with 74% sensitivity and 88% specificity, while CPC predicted the absence of pulse with 91% sensitivity and 61% specificity. CONCLUSION CoFe PuC provides much earlier and more effective information about the pulse than CPC. This shortens the interruption times in CPR. CoFe PuC should be recommended as a new and useful method in CPR guidelines.
Collapse
Affiliation(s)
- E Sonmez
- Kütahya Health Sciences University, Medical School, Department of Emergency Medicine, Kütahya, Turkey
| | - B Taslidere
- Bezmialem Vakif University Medical Faculty, Department of Emergency Medicine, İstanbul, Turkey
| | - A Ozkan
- Bağcılar Training And Research Hospital, Department of Emergency Medicine, İstanbul, Turkey.
| |
Collapse
|
4
|
Lee MS, Sweetnam-Holmes D, Soffer GP, Harel-Sterling M. Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine. Curr Opin Pediatr 2024; 36:256-265. [PMID: 38411588 DOI: 10.1097/mop.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW There is expanding evidence for point-of-care ultrasound (POCUS) use in pediatric emergency medicine - this review highlights the benefits and challenges in the clinical integration of high-yield POCUS applications. Specifically, it will delve into POCUS applications during resuscitations, controversies of Focused Assessment with Sonography for Trauma (FAST) in pediatric trauma, POCUS-guided procedures, and examples of clinical pathways where POCUS can expedite definitive care. RECENT FINDINGS POCUS can enhance diagnostic accuracy and aid in management of pediatric patients in shock and help identify reversible causes during cardiac arrest. The use of the FAST in pediatric blunt abdominal trauma remains nuanced - its proper use requires an integration with clinical findings and an appreciation of its limitations. POCUS has been shown to enhance safety and efficacy of procedures such as nerve blocks, incision & drainage, and intravenous access. Integrating POCUS into pathways for conditions such as intussusception and testicular torsion expedites downstream care. SUMMARY POCUS enhances diagnostic efficiency and management in pediatric patients arriving at the ED with undifferentiated shock, cardiac arrest, or trauma. Additionally, POCUS improves procedural success and safety, and is integral to clinical pathways for expediting definitive care for various pediatric emergencies. Future research should continue to focus on the impact of POCUS on patient outcomes, ensuring user competency, and the expansion of POCUS into diverse settings.
Collapse
Affiliation(s)
- Michelle Sin Lee
- Pediatric Emergency Medicine, Hospital for Sick Children, Assistant Professor, University of Toronto, Toronto, ON, Canada
| | | | | | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Magon F, Longhitano Y, Savioli G, Piccioni A, Tesauro M, Del Duca F, Napoletano G, Volonnino G, Maiese A, La Russa R, Di Paolo M, Zanza C. Point-of-Care Ultrasound (POCUS) in Adult Cardiac Arrest: Clinical Review. Diagnostics (Basel) 2024; 14:434. [PMID: 38396471 PMCID: PMC10887671 DOI: 10.3390/diagnostics14040434] [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: 12/30/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Point-of-Care Ultrasound (POCUS) is a rapid and valuable diagnostic tool available in emergency and intensive care units. In the context of cardiac arrest, POCUS application can help assess cardiac activity, identify causes of arrest that could be reversible (such as pericardial effusion or pneumothorax), guide interventions like central line placement or pericardiocentesis, and provide real-time feedback on the effectiveness of resuscitation efforts, among other critical applications. Its use, in addition to cardiovascular life support maneuvers, is advocated by all resuscitation guidelines. The purpose of this narrative review is to summarize the key applications of POCUS in cardiac arrest, highlighting, among others, its prognostic, diagnostic, and forensic potential. We conducted an extensive literature review utilizing PubMed by employing key search terms regarding ultrasound and its use in cardiac arrest. Apart from its numerous advantages, its limitations and challenges such as the potential for interruption of chest compressions during image acquisition and operator proficiency should be considered as well and are discussed herein.
Collapse
Affiliation(s)
- Federica Magon
- Department of Anesthesia and Critical Care, Bicocca University of Milano, 20126 Milano, Italy;
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Gabriele Savioli
- Departement of Emergency, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli Hospital, Catholic University of Rome, 00168 Rome, Italy;
| | - Manfredi Tesauro
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| |
Collapse
|
7
|
Kameda T, Ishii H, Oya S, Katabami K, Kodama T, Sera M, Takei H, Taniguchi H, Nakao S, Funakoshi H, Yamaga S, Senoo S, Kimura A. Guidance for clinical practice using emergency and point-of-care ultrasonography. Acute Med Surg 2024; 11:e974. [PMID: 38933992 PMCID: PMC11201855 DOI: 10.1002/ams2.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Owing to the miniaturization of diagnostic ultrasound scanners and their spread of their bedside use, ultrasonography has been actively utilized in emergency situations. Ultrasonography performed by medical personnel with focused approaches at the bedside for clinical decision-making and improving the quality of invasive procedures is now called point-of-care ultrasonography (POCUS). The concept of POCUS has spread worldwide; however, in Japan, formal clinical guidance concerning POCUS is lacking, except for the application of focused assessment with sonography for trauma (FAST) and ultrasound-guided central venous cannulation. The Committee for the Promotion of POCUS in the Japanese Association for Acute Medicine (JAAM) has often discussed improving the quality of acute care using POCUS, and the "Clinical Guidance for Emergency and Point-of-Care Ultrasonography" was finally established with the endorsement of JAAM. The background, targets for acute care physicians, rationale based on published articles, and integrated application were mentioned in this guidance. The core points include the fundamental principles of ultrasound, airway, chest, cardiac, abdominal, and deep venous ultrasound, ultrasound-guided procedures, and the usage of ultrasound based on symptoms. Additional points, which are currently being considered as potential core points in the future, have also been widely mentioned. This guidance describes the overview and future direction of ultrasonography for acute care physicians and can be utilized for emergency ultrasound education. We hope this guidance will contribute to the effective use of ultrasonography in acute care settings in Japan.
Collapse
Affiliation(s)
- Toru Kameda
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Clinical Laboratory MedicineJichi Medical UniversityShimotsukeJapan
| | - Hiromoto Ishii
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Seiro Oya
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineShizuoka Medical CenterShizuokaJapan
| | - Kenichi Katabami
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care CenterHokkaido University HospitalSapporoJapan
| | - Takamitsu Kodama
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and General Internal MedicineTajimi City HospitalTajimiJapan
| | - Makoto Sera
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineFukui Prefectural HospitalFukuiJapan
| | - Hirokazu Takei
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency MedicineHyogo Prefectural Kobe Children's HospitalKobeJapan
| | - Hayato Taniguchi
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Shunichiro Nakao
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hiraku Funakoshi
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu Ichikawa Medical CenterUrayasuJapan
| | - Satoshi Yamaga
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Radiation Disaster Medicine, Research Institute for Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
| | - Satomi Senoo
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical Care MedicineSaiseikai Yokohamashi Tobu HospitalYokohamaJapan
| | - Akio Kimura
- Committee for the Promotion of Point‐of‐Care UltrasonographyJapanese Association for Acute MedicineJapan
- Department of Emergency and Critical CareCenter Hospital of the National Center for Global Health and MedicineTokyoJapan
| |
Collapse
|
8
|
Pasierski J, Kleger GR, Imboden P. Do we need standardized management after termination-of-resuscitation attempts? Autoresuscitation in a 67-year-old woman. Scand J Trauma Resusc Emerg Med 2023; 31:62. [PMID: 37884989 PMCID: PMC10601331 DOI: 10.1186/s13049-023-01137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Autoresuscitation is the phenomenon of spontaneous return of circulation after cessation of CPR, also known as the Lazarus phenomenon. Most of the evidence is based on case reports and a few systematic reviews. The occurrence of autoresuscitation may lead to self-reproach and dismay in affected emergency personnel and may rise questions about the correct procedure after terminating resuscitative efforts. In contrast to existing cardiac arrest guidelines there is no standardized approach to terminating resuscitative attempts. CASE We report a case of out of hospital autoresuscitation in a 67-year-old female after 60 min of advanced cardiac life support. After shock refractory shockable rhythm, we recorded pulseless electrical activity and fixed pupils, consequently resuscitation was terminated. About 50 min later the patient surprisingly showed signs of life. Due to the suggestive history a coronary angiography was performed, showing severe coronary heart disease which necessitated surgical intervention. After ACBP surgery and intensive care followed by treatment on the cardiological ward, she was finally discharged to neurological rehabilitation. CONCLUSION As already proposed by existing literature, there should be at least a 10-min interval of close monitoring after abandoning CPR. Transport of a deceased patient should only take place after secure signs of death can be detected. Further investigation is needed to determine which patients are most likely to benefit from an extended observation period. Our case reports highlights the difficulties in death declaration and the importance of close monitoring after abandoning CPR.
Collapse
Affiliation(s)
- Janina Pasierski
- Department of Internal Medicine, Cantonal Hospital St. Gallen, 9007, St. Gallen, Switzerland.
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Gian-Reto Kleger
- Department of Internal Medicine, Cantonal Hospital St. Gallen, 9007, St. Gallen, Switzerland
- Department for Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Paul Imboden
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Paramedic Emergency Department, Emergency Physician (SGNOR), St. Gallen, Switzerland
| |
Collapse
|
9
|
Özlü S, Bilgin S, Yamanoglu A, Kayalı A, Efgan MG, Çınaroğlu OS, Tekyol D. Comparison of carotid artery ultrasound and manual method for pulse check in cardiopulmonary resuscitation. Am J Emerg Med 2023; 70:157-162. [PMID: 37327681 DOI: 10.1016/j.ajem.2023.05.045] [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: 01/26/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES The success of the manual pulse check method frequently employed during cardiopulmonary resuscitation (CPR) is controversial due to its subjective, patient- and operator-dependent, and time-consuming nature. Carotid ultrasound (c-USG) has recently emerged as an alternative, although there are still insufficient studies on the subject. The purpose of the present study was to compare the success of the manual and c-USG pulse check methods during CPR. METHODS This prospective observational study was conducted in the critical care area of a university hospital emergency medicine clinic. Pulse checks in patients with non-traumatic cardiopulmonary arrest (CPA) undergoing CPR were performed using the c-USG method from one carotid artery and the manual method from the other. The gold standard in the decision regarding return of spontaneous circulation (ROSC) was the clinical judgment made using the rhythm on the monitor, manual femoral pulse check, end tidal carbon dioxide (ETCO2), and cardiac USG instruments. The success in predicting ROSC and measurement times of the manual and c-USG methods were compared. The success of both methods was calculated as sensitivity and specificity, and the clinical significance of the difference between the methods' sensitivity and specificity was evaluated Newcombe's method. RESULTS A total of 568 pulse measurements were performed on 49 CPA cases using both c-USG and the manual method. The manual method exhibited 80% sensitivity and 91% specificity in predicting ROSC (+PV: 35%, -PV: 64%), while c-USG exhibited 100% sensitivity and 98% specificity (+PV: 84%, -PV: 100%). The difference in sensitivities between the c-USG and manual methods was -0.0704 (95% CI: -0.0965; -0.0466), and the difference between their specificities was 0.0106 (95% CI: 0.0006; 0.0222). The difference between the specificities and sensitivities was statistically significant at analysis performed adopting the clinical judgment of the team leader using multiple instruments as the gold standard. The manual method yielded an ROSC decision in 3 ± 0.17 s and c-USG in 2.8 ± 0.15 s, the difference being statistically significant. CONCLUSION According to the results of this study, the pulse check method with c-USG may be superior to the manual method in terms of fast and accurate decision making in CPR.
Collapse
Affiliation(s)
- Sercan Özlü
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital Izmir, Türkiye
| | - Serkan Bilgin
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital Izmir, Türkiye
| | - Adnan Yamanoglu
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital Izmir, Türkiye.
| | - Ahmet Kayalı
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital Izmir, Türkiye
| | - Mehmet Göktuğ Efgan
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital Izmir, Türkiye
| | - Osman Sezer Çınaroğlu
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital Izmir, Türkiye
| | - Davut Tekyol
- Department of Emergency medicine, Health Science university, Haydarpaşa Numune Training and Research Hospital, Istanbul, Türkiye
| |
Collapse
|
10
|
Leviter JI, Chen L, O'Marr J, Riera A. The Feasibility of Using Point-of-Care Ultrasound During Cardiac Arrest in Children: Rapid Apical Contractility Evaluation. Pediatr Emerg Care 2023; 39:347-350. [PMID: 35470313 DOI: 10.1097/pec.0000000000002741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Resuscitation guidelines emphasize minimal interruption of compressions during cardiopulmonary resuscitation. Point-of-care ultrasound (POCUS) enables the clinician to visualize cardiac contractility and central artery pulsatility. The apical 4-chamber (A4), subxiphoid (SX), and femoral artery views may be used when defibrillator pads or active compressions preclude parasternal cardiac views. We hypothesized that clinicians can rapidly obtain interpretable POCUS views in healthy children from the A4, SX, and femoral positions. METHODS A prospective study of pediatric emergency medicine providers in an urban academic hospital was performed. Stable patients of 12 years or younger were scanned. Sonologists were each allotted 10 seconds to acquire A4, SX, and femoral views. Two attempts at each view were allowed. The primary outcome was whether cardiac and femoral artery scans were interpretable for contractility and pulsatility, respectively. The secondary outcome was whether cardiac scans were interpretable for effusion or right ventricular strain. A POCUS expert reviewed scans to confirm interpretability. RESULTS Twenty-two sonologists performed a total of 50 scans on 22 patients. A view that was interpretable for contractility was obtained on the first attempt in 86% of A4 and 94% of SX scans. A femoral view that was interpretable for pulsatility was obtained on the first attempt in 74% of scans. Expert review was concordant with sonologist interpretation. CONCLUSIONS Pediatric emergency medicine physicians can obtain interpretable cardiac and central artery views within 10 seconds most of the time. Point-of-care ultrasound has the potential to enhance care during pediatric resuscitation. Future studies on the impact of POCUS pulse checks in actual pediatric resuscitations should be performed.
Collapse
Affiliation(s)
- Julie I Leviter
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine
| | - Lei Chen
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine
| | | | - Antonio Riera
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine
| |
Collapse
|
11
|
DeMasi S, Joyce M. The use of spectral Doppler to detect return of spontaneous circulation, a novel alternative to manual palpation. Resuscitation 2023; 184:109717. [PMID: 36740092 DOI: 10.1016/j.resuscitation.2023.109717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Stephanie DeMasi
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, United States.
| | - Michael Joyce
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, United States; Department of Diagnostic Radiology, Virginia Commonwealth University, Richmond, VA, United States
| |
Collapse
|
12
|
Haddad G, Margius D, Cohen AL, Gorlin M, Jafari D, Li T, Owens C, Becker L, Rolston DM. Doppler ultrasound peak systolic velocity versus end tidal carbon dioxide during pulse checks in cardiac arrest. Resuscitation 2023; 183:109695. [PMID: 36646373 DOI: 10.1016/j.resuscitation.2023.109695] [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: 11/14/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND An accurate, non-invasive measure of return of spontaneous circulation (ROSC) is needed to improve management of cardiac arrest patients. OBJECTIVES During a pulse check in Emergency Department (ED) cardiac arrest patients, we compared the correlation between 1) end tidal carbon dioxide (ETCO2) and systolic blood pressure (SBP), and 2) Doppler ultrasound peak systolic velocity (PSV) and SBP. Additionally, we assessed the accuracy of PSV ≥ 20 cm/sec in comparison to previously suggested ETCO2 ≥ 20 or ≥ 25 mmHg thresholds to predict ROSC with SBP ≥ 60 mmHg. METHODS This was a secondary analysis of a previously published prospective observational study of ED cardiac arrest patients with an advanced airway and femoral arterial line in place. During each pulse check, highest SBP, highest PSV, and ETCO2 at the end of the pulse check were recorded. Spearman correlation coefficients were calculated and compared using a Fisher Z-transformation. Accuracy of previously determined PSV and ETCO2 thresholds for detecting ROSC with SBP ≥ 60 mmHg were compared using McNemar's tests. RESULTS Based on data from 35 patients with 111 pulse checks, we found a higher correlation between PSV and SBP than ETCO2 and SBP (0.71 vs 0.31; p < 0.001). Diagnostic accuracy of PSV ≥ 20 cm/sec for detecting ROSC with SBP ≥ 60 mmHg was 89% (95% CI: 82%-94%) versus 59% (95% CI: 49%-68%) and 58% (95% CI: 48%-67%) for ETCO2 ≥ 20 and ≥ 25 mmHg, respectively. CONCLUSIONS During a pulse check, Doppler ultrasound PSV outperformed ETCO2 for correlation with SBP and accuracy in detecting ROSC with SBP ≥ 60 mmHg.
Collapse
Affiliation(s)
- Ghania Haddad
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States.
| | - Deanna Margius
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, United States
| | - Allison L Cohen
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, United States
| | - Margaret Gorlin
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Daniel Jafari
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, United States; Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
| | - Timmy Li
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, United States
| | - Casey Owens
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Lance Becker
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, United States; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Daniel M Rolston
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, United States; Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
| |
Collapse
|
13
|
Humphries AL, White JMB, Guinn RE, Braude DA. Paramedic-Performed Carotid Artery Ultrasound Heralds Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Case Report. PREHOSP EMERG CARE 2023; 27:107-111. [PMID: 34990301 DOI: 10.1080/10903127.2021.2022257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Point-of-Care Ultrasound (POCUS) has been demonstrated to have multiple applications in the care of critically ill and injured patients, especially given its portability and ease of use. These characteristics of POCUS make it ideal for use in the prehospital environment as well. We present a case that highlights a novel application of ultrasound in the prehospital management of out-of-hospital cardiac arrest (OHCA).
Collapse
Affiliation(s)
- Amanda L Humphries
- Department of Emergency Medicine, Houston McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Jenna M B White
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - R Elliott Guinn
- Rio Rancho Fire Rescue, City of Rio Rancho, Rio Rancho, New Mexico, USA
| | - Darren A Braude
- Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA.,Rio Rancho Fire Rescue, City of Rio Rancho, Rio Rancho, New Mexico, USA.,Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
14
|
Leviter JI, Walsh S, Riera A. Point-of-Care Ultrasound for Pulse Checks in Pediatric Cardiac Arrest: Two Illustrative Cases. Pediatr Emerg Care 2023; 39:60-61. [PMID: 35477928 DOI: 10.1097/pec.0000000000002743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Cardiac arrest is an infrequent but high-stakes scenario in pediatrics. Manual central pulse checks are unreliable. Point-of-care ultrasound is a noninvasive technique to visualize the heart and central vessels during resuscitation. We describe 2 cases in which point-of-care ultrasound helped aid management decisions in pediatric cardiac arrest.
Collapse
|
15
|
The Evolving Role of Ultrasound in Prehospital and Emergency Medicine. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Gottlieb M, Alerhand S. Managing Cardiac Arrest Using Ultrasound. Ann Emerg Med 2022; 81:532-542. [PMID: 36334956 DOI: 10.1016/j.annemergmed.2022.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022]
|
17
|
Easter SR, Hameed AB, Shamshirsaz A, Fox K, Zelop CM. Point of care maternal ultrasound in obstetrics. Am J Obstet Gynecol 2022; 228:509.e1-509.e13. [PMID: 36183775 DOI: 10.1016/j.ajog.2022.09.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 01/25/2023]
Abstract
Ultrasound is the hallmark imaging modality traditionally used by obstetricians for fetal diagnosis and surveillance. The COVID-19 pandemic highlighted the role of point of care ultrasound for expeditious assessment of the maternal cardiopulmonary status. The familiarity of obstetricians with ultrasound, coupled with the availability of ultrasound equipment without the need to transport the patient, make point of care ultrasound particularly valuable in the labor and delivery unit. The rising contribution of cardiopulmonary disorders to maternal morbidity and mortality carves out many potential applications for point of care ultrasound during labor and delivery. Obstetricians have access to the technology and the skills to obtain the basic views required to assess for the presence of pulmonary edema, ventricular dysfunction, or intra-abdominal free fluid. Point of care ultrasound can be used routinely for the evaluation of pulmonary complaints or in the assessment of hypotension and may play an essential role in the diagnosis and management of life-threatening emergencies such as shock, an amniotic fluid embolism, or cardiac arrest. We reviewed the currently established point of care ultrasound protocols for the evaluation of cardiopulmonary complaints through the lens of the obstetrician. We call on educators and academic leaders to incorporate maternal point of care ultrasound teachings into existing curricula. Point of care ultrasound is of enormous value for providers with limited access to diagnostic imaging or subspecialty providers. With the growing complexity of the obstetrical population, acquiring the clinical skills to meet these evolving needs is a requisite step in the ongoing efforts to reduce maternal morbidity and mortality.
Collapse
Affiliation(s)
- Sarah Rae Easter
- Division of Maternal-Fetal Medicine and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Afshan B Hameed
- Division of Maternal Fetal Medicine and Cardiology, University of California, Irvine, CA
| | - Amir Shamshirsaz
- Division of Maternal-Fetal Medicine and Surgical Critical Care, Baylor College of Medicine, Houston, TX
| | - Karin Fox
- Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX
| | - Carolyn M Zelop
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Valley Hospital, Ridgewood, NJ; Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| |
Collapse
|
18
|
Rolston DM. Time is Running Out for Manual Pulse Checks as Ultrasound Races Past. Resuscitation 2022; 179:59-60. [PMID: 35908671 DOI: 10.1016/j.resuscitation.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel M Rolston
- Departments of Emergency Medicine & Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
| |
Collapse
|
19
|
Yeon Kang S, Joon Jo I, Lee G, Eun Park J, Kim T, Uk Lee S, Yeon Hwang S, Gun Shin T, Kim K, Sun Shim J, Yoon H. Point-of-Care Ultrasound Compression of the Carotid Artery for Pulse Determination in Cardiopulmonary Resuscitation. Resuscitation 2022; 179:206-213. [PMID: 35792305 DOI: 10.1016/j.resuscitation.2022.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
AIM To identify whether a novel pulse check technique, carotid artery compression using an ultrasound probe, can reduce pulse check times compared to manual palpation (MP). METHODS This prospective study was conducted in an emergency department between February and December 2021. A physician applied point-of-care ultrasound-carotid artery compression (POCUS-CAC) and assessed the carotid artery compressibility and pulsatility by probe compression during rhythm check time. Another clinician performed MP of the femoral artery. The primary outcome was the difference in the average time for pulse assessment between POCUS-CAC and MP. The secondary outcomes included the time difference in each pulse check between methods, the proportion of times greater than 5 s and 10 s, and the prediction of return of spontaneous circulation (ROSC) during ongoing chest compression. RESULTS 25 cardiac arrest patients and 155 pulse checks were analyzed. The median (interquartile range) average time to carotid pulse identification per patient using POCUS-CAC was 1.62 (1.14-2.14) s compared to 3.50 (2.99-4.99) s with MP. In all 155 pulse checks, the POCUS-CAC time to determine ROSC was significantly shortened to 0.44 times the MP time (P < 0.001). The POCUS-CAC approach never exceeded 10 s, and the number of patients who required more than 5 s was significantly lower (5 vs. 37, P < 0.001). Under continuous chest compression, six pulse checks predicted the ROSC. CONCLUSIONS We found that emergency physicians could quickly determine pulses by applying simple POCUS compression of the carotid artery in cardiac arrest patients.
Collapse
Affiliation(s)
- Soo Yeon Kang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea; Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea; Department of Data Convergence & Future Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Ji Sun Shim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
| |
Collapse
|
20
|
Noordergraaf GJ, Venema A. Way to go: PEA in the in-hospital setting, a step to return of spontaneous circulation. Resuscitation 2022; 176:64-65. [PMID: 35644306 DOI: 10.1016/j.resuscitation.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Gerrit J Noordergraaf
- Department of Anesthesiology, Resuscitation & Pain Management, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands.
| | - Alyssa Venema
- Department of Anesthesiology, Resuscitation & Pain Management, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| |
Collapse
|
21
|
Cohen AL, Li T, Becker LB, Owens C, Singh N, Gold A, Nelson MJ, Jafari D, Haddad G, Nello AV, Rolston DM, Sisson C, Lesser ML. Femoral Artery Doppler Ultrasound is more Accurate than Manual Palpation for Pulse Detection in Cardiac Arrest. Resuscitation 2022; 173:156-165. [DOI: 10.1016/j.resuscitation.2022.01.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/06/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
|
22
|
Carotid Artery Ultrasound in the (peri-) Arrest Setting—A Prospective Pilot Study. J Clin Med 2022; 11:jcm11020469. [PMID: 35054163 PMCID: PMC8780199 DOI: 10.3390/jcm11020469] [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] [Received: 12/18/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 01/25/2023] Open
Abstract
Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and feasibility during CPR are not fully determined. In this prospective observational study, we performed carotid US during conventional- and extracorporeal CPR and after ROSC with at least one transverse and coronal image, corresponding loops with and without color doppler, and pulsed-wave doppler loops. The feasibility of carotid US during (peri-)arrest and type and frequency of diagnostic findings were examined. We recruited 16 patients and recorded utilizable US images in 14 cases (88%; complete imaging protocols in 11 patients [69%]). In three of all patients (19%) and in 60% (3/5) of cases during CPR plus a full imaging protocol, we observed: (i) in one patient a collapse of the common carotid artery linked to hypovolemia, and (ii) in two patients a biphasic flow during CPR linked to prolonged low-flow time prior to admission and adverse outcome. Carotid artery morphology and carotid blood flow characteristics may serve as therapeutic target and prognostic parameters. However, future studies with larger sample sizes are needed.
Collapse
|
23
|
Abstract
AIM Paramedics received training in point-of-care ultrasound (POCUS) to assess for cardiac contractility during management of medical out-of-hospital cardiac arrest (OHCA). The primary outcome was the percentage of adequate POCUS video acquisition and accurate video interpretation during OHCA resuscitations. Secondary outcomes included POCUS impact on patient management and resuscitation protocol adherence. METHODS A prospective, observational cohort study of paramedics was performed following a four-hour training session, which included a didactic lecture and hands-on POCUS instruction. The Prehospital Echocardiogram in Cardiac Arrest (PECA) protocol was developed and integrated into the resuscitation algorithm for medical non-shockable OHCA. The ultrasound (US) images were reviewed by a single POCUS expert investigator to determine the adequacy of the POCUS video acquisition and accuracy of the video interpretation. Change in patient management and resuscitation protocol adherence data, including end-tidal carbon dioxide (EtCO2) monitoring following advanced airway placement, adrenaline administration, and compression pauses under ten seconds, were queried from the prehospital electronic health record (EHR). RESULTS Captured images were deemed adequate in 42/49 (85.7%) scans and paramedic interpretation of sonography was accurate in 43/49 (87.7%) scans. The POCUS results altered patient management in 14/49 (28.6%) cases. Paramedics adhered to EtCO2 monitoring in 36/36 (100.0%) patients with an advanced airway, adrenaline administration for 38/38 (100.0%) patients, and compression pauses under ten seconds for 36/38 (94.7%) patients. CONCLUSION Paramedics were able to accurately obtain and interpret cardiac POCUS videos during medical OHCA while adhering to a resuscitation protocol. These findings suggest that POCUS can be effectively integrated into paramedic protocols for medical OHCA.
Collapse
|
24
|
Schwartz BE, Gandhi P, Najafali D, Gregory MM, Jacob N, Helberg T, Thomas C, Lowie BJ, Huis In 't Veld MA, Cruz-Cano R. Manual Palpation vs. Femoral Arterial Doppler Ultrasound for Comparison of Pulse Check Time During Cardiopulmonary Resuscitation in the Emergency Department: A Pilot Study. J Emerg Med 2021; 61:720-730. [PMID: 34920840 DOI: 10.1016/j.jemermed.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/15/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Manual palpation (MP) is frequently employed for pulse checks, but studies have shown that trained medical personnel have difficulty accurately identifying pulselessness or return of spontaneous circulation (ROSC) using MP. Any delays in identifying pulselessness can lead to significant delays in starting or resuming high-quality chest compressions. OBJECTIVES This study explored whether femoral arterial Doppler ultrasound (FADU) decreases pulse check duration during cardiopulmonary resuscitation (CPR) compared with MP among patients in the emergency department (ED) receiving CPR directed by emergency medicine physicians who had received minimal additional didactic ultrasound training. METHODS We performed a prospective observational cohort study from October 2018 to May 2019 at an urban community ED. Using convenience sampling, we enrolled patients arriving at our ED or who decompensated during their ED stay and received CPR. For continuous data, median (interquartile range [IQR]) were calculated, and medians were compared using Kruskal-Wallis test. RESULTS Fifty-two eligible patients were enrolled and 135 pulse checks via MP and 35 via FADU were recorded. MP observations had a median (IQR) of 11.00 (7.36-15.48) s, whereas FADU had a median (IQR) of 8.98 (5.45-13.85) s. There was a difference between the two medians of 2.02 s (p = 0.05). CONCLUSIONS In this study, the use of FADU was superior to MP in achieving shorter pulse check times. Further research is needed to confirm the accuracy of FADU for identifying ROSC as well as to determine whether FADU can improve clinical outcomes.
Collapse
Affiliation(s)
- Brad E Schwartz
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, University of Maryland Capital Region Health, UM Prince George's Hospital Center, Cheverly, Maryland
| | - Priyanka Gandhi
- The Emergency Medicine Research Associate Program, Department of Emergency Medicine, University of Maryland Capital Region Health, UM Prince George's Hospital Center, Cheverly, Maryland
| | - Daniel Najafali
- The Emergency Medicine Research Associate Program, Department of Emergency Medicine, University of Maryland Capital Region Health, UM Prince George's Hospital Center, Cheverly, Maryland
| | - Melissa Meade Gregory
- The Emergency Medicine Research Associate Program, Department of Emergency Medicine, University of Maryland Capital Region Health, UM Prince George's Hospital Center, Cheverly, Maryland; Ross University School of Medicine, Bridgetown, Barbados
| | - Nirmal Jacob
- The Emergency Medicine Research Associate Program, Department of Emergency Medicine, University of Maryland Capital Region Health, UM Prince George's Hospital Center, Cheverly, Maryland
| | - Travis Helberg
- Ross University School of Medicine, Bridgetown, Barbados
| | - Celina Thomas
- The Emergency Medicine Research Associate Program, Department of Emergency Medicine, University of Maryland Capital Region Health, UM Prince George's Hospital Center, Cheverly, Maryland
| | - Bobbi-Jo Lowie
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Maite A Huis In 't Veld
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Raul Cruz-Cano
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland
| |
Collapse
|
25
|
Affiliation(s)
- José L Díaz-Gómez
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Paul H Mayo
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Seth J Koenig
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| |
Collapse
|
26
|
Smith DJ, Simard R, Chenkin J. Checking the pulse in the 21st century: Interobserver reliability of carotid pulse detection by point-of-care ultrasound. Am J Emerg Med 2020; 45:280-283. [PMID: 33046297 DOI: 10.1016/j.ajem.2020.08.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Detection of a pulse is crucial to decision-making in the care of patients who are in cardiac arrest, however, the current standard of manual pulse palpation is unreliable. An emerging alternative is the use of point-of-care ultrasound (POCUS) for direct assessment of the carotid pulse. The primary objective of this study is to determine the interobserver reliability for physician interpretation of pre-recorded point-of-care ultrasound pulse-check clips for patients who are in cardiac arrest. METHODS We conducted a web-based survey of residents and physicians working in an academic center. Participants were shown a tutorial demonstrating POCUS detection of the carotid pulse and then asked to interpret 15 carotid pulse ultrasound clips from patients who were in cardiac arrest. The primary outcome was interobserver reliability for carotid pulse assessment. Secondary outcomes included interobserver reliability stratified by physician role and POCUS experience, median tutorial and median pulse assessment duration. Interobserver reliability was determined by Krippendorff's ⍺. RESULTS 68 participants completed the study, with a response rate of 75%. There was high interobserver reliability for pulse assessment amongst all study participants (⍺ = 0.874, 95% CI 0.869 to 0.879). All sub-groups had ⍺ greater than 0.8. Median tutorial duration was 35 s (IQR 29). Median pulse assessment duration was 6 s (IQR 5) with 76% of assessments completed within 10 s. CONCLUSION Interpretation of the carotid pulse by POCUS showed high interobserver reliability. Further work must be done to determine the performance of POCUS pulse assessment in real-time for patients who are in cardiac arrest.
Collapse
Affiliation(s)
- David J Smith
- Division of Emergency Medicine, University of Toronto, C. David Naylor Building, 3rd Floor 6 Queen's Park Crescent West, Toronto, ON M5S 3H2, Canada.
| | - Robert Simard
- Division of Emergency Medicine, University of Toronto, C. David Naylor Building, 3rd Floor 6 Queen's Park Crescent West, Toronto, ON M5S 3H2, Canada; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, AG245, Toronto, ON M4N 3M5, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, University of Toronto, C. David Naylor Building, 3rd Floor 6 Queen's Park Crescent West, Toronto, ON M5S 3H2, Canada; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, AG245, Toronto, ON M4N 3M5, Canada
| |
Collapse
|
27
|
Assessing the validity of two-dimensional carotid ultrasound to detect the presence and absence of a pulse. Resuscitation 2020; 157:67-73. [PMID: 33058995 DOI: 10.1016/j.resuscitation.2020.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/08/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Traditional assessment of return of cardiac output in cardiac arrest by manual palpation has poor accuracy. Point of care ultrasound of a major artery has been suggested as an alternative. We conducted a diagnostic accuracy study of two-dimensional carotid ultrasound to detect the presence or absence of a pulse, using cardiopulmonary bypass patients for pulse and pulseless states. METHODS A cross-sectional multi-patient, multi-reader repeated measures diagnostic study was conducted. For patients undergoing routine cardiopulmonary bypass, a portable ultrasound was used to record four 10-s videos the common carotid artery, three aimed for a pulse in high (>90 mmHg), medium (70-90 mmHg) and low (<70 mmHg) systolic blood pressure (SBP) ranges, and a pulseless video was recorded on cardiopulmonary bypass. Critical care physicians viewed the videos and were asked to nominate within 10 s if a pulse was present. True pulse-status was determined via the arterial-line waveform. RESULTS Twenty-three patients had all four videos collected. Median patient age was 64 (IQR 14), sixteen were male (70%) and median BMI was 27. The median SBP in high-, medium- and low-SBP groups were 120 mmHg, 83 mmHg and 69 mmHg respectively. Forty-six physicians reviewed a subset of 24 videos. Overall sensitivity was 0.91 (95% confidence interval 0.89-0.93) and specificity 0.90 (95% CI 0.86-0.93). Sensitivity was highest in the high-SBP group (0.96, 95% CI 0.93-0.98) and lowest in the low-SBP group (0.83, 95% CI 0.78-0.87). CONCLUSION 2D ultrasound of the common carotid artery is both sensitive and specific for detection of the presence or absence of a pulse.
Collapse
|
28
|
Cardiac arrest without pulse checks. Resuscitation 2020; 147:112-113. [DOI: 10.1016/j.resuscitation.2019.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
|