1
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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.
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Affiliation(s)
- Michelle Sin Lee
- Pediatric Emergency Medicine, Hospital for Sick Children, Assistant Professor, University of Toronto, Toronto, ON, Canada
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Meng L, Rasmussen M, Abcejo AS, Meng DM, Tong C, Liu H. Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions. Anesth Analg 2024; 138:1215-1232. [PMID: 37788395 DOI: 10.1213/ane.0000000000006664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Perioperative cardiac arrest (POCA) is a catastrophic complication that requires immediate recognition and correction of the underlying cause to improve patient outcomes. While the hypoxia, hypovolemia, hydrogen ions (acidosis), hypo-/hyperkalemia, and hypothermia (Hs) and toxins, tamponade (cardiac), tension pneumothorax, thrombosis (pulmonary), and thrombosis (coronary) (Ts) mnemonic is a valuable tool for rapid differential diagnosis, it does not cover all possible causes leading to POCA. To address this limitation, we propose using the preload-contractility-afterload-rate and rhythm (PCARR) construct to categorize POCA, which is comprehensive, systemic, and physiologically logical. We provide evidence for each component in the PCARR construct and emphasize that it complements the Hs and Ts mnemonic rather than replacing it. Furthermore, we discuss the significance of utilizing monitored variables such as electrocardiography, pulse oxygen saturation, end-tidal carbon dioxide, and blood pressure to identify clues to the underlying cause of POCA. To aid in investigating POCA causes, we suggest the Anesthetic care, Surgery, Echocardiography, Relevant Check and History (A-SERCH) list of actions. We recommend combining the Hs and Ts mnemonic, the PCARR construct, monitoring, and the A-SERCH list of actions in a rational manner to investigate POCA causes. These proposals require real-world testing to assess their feasibility.
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Affiliation(s)
- Lingzhong Meng
- From the Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mads Rasmussen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Arnoley S Abcejo
- Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Deyi M Meng
- Choate Rosemary Hall School, Wallingford, Connecticut
| | - Chuanyao Tong
- Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, California
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3
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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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García-Vilana S, Kumar V, Kumar S, Barberia E, Landín I, Granado-Font E, Solà-Muñoz S, Jiménez-Fàbrega X, Bardají A, Hardig BM, Azeli Y. Study of risk factors for injuries due to cardiopulmonary resuscitation with special focus on the role of the heart: A machine learning analysis of a prospective registry with multiple sources of information (ReCaPTa Study). Resusc Plus 2024; 17:100559. [PMID: 38586866 PMCID: PMC10995644 DOI: 10.1016/j.resplu.2024.100559] [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: 11/01/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 04/09/2024] Open
Abstract
Background The study of thoracic injuries and biomechanics during CPR requires detailed studies that are very scarce. The role of the heart in CPR biomechanics has not been determined. This study aimed to determine the risk factors importance for serious ribcage damage due to CPR. Methods Data were collected from a prospective registry of out-of-hospital cardiac arrest between April 2014 and April 2017. This study included consecutive out-of-hospital CPR attempts undergoing an autopsy study focused on CPR injuries. Cardiac mass ratio was defined as the ratio of real to expected heart mass. Pearson's correlation coefficient was used to select clinically relevant variables and subsequently classification tree models were built. The Gini index was used to determine the importance of the associated serious ribcage damage factors. The LUCAS® chest compressions device forces and the cardiac mass were analyzed by linear regression. Results Two hundred CPR attempts were included (133 manual CPR and 67 mechanical CPR). The mean age of the sample was 60.4 ± 13.5, and 56 (28%) were women. In all, 65.0% of the patients presented serious ribcage damage. From the classification tree build with the clinically relevant variables, age (0.44), cardiac mass ratio (0.26), CPR time (0.22), and mechanical CPR (0.07), in that order, were the most influential factors on serious ribcage damage. The chest compression forces were greater in subjects with higher cardiac mass. Conclusions The heart plays a key role in CPR biomechanics being cardiac mass ratio the second most important risk factor for CPR injuries.
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Affiliation(s)
- Silvia García-Vilana
- Universitat Politècnica de Catalunya (UPC-EPSEVG), Grup de Recerca Aplicada en Biomecànica de l’Impacte (GRABI), Barcelona, Spain
| | - Vikas Kumar
- Environmental Engineering Laboratory, Departament d' Enginyeria Quimica, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
| | - Saurav Kumar
- Environmental Engineering Laboratory, Departament d' Enginyeria Quimica, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
| | - Eneko Barberia
- Institut de Medicina Legal i Ciencies Forenses de Catalunya (IMLCFC), Spain
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Inés Landín
- Institut de Medicina Legal i Ciencies Forenses de Catalunya (IMLCFC), Spain
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Ester Granado-Font
- Centre d'Atenció Primària Horts de Miró (Reus-4), Institut Català de Salut, Reus, Spain
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain
| | - Silvia Solà-Muñoz
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Sistema d’Emergències Mèdiques de Catalunya, Spain
| | - Xavier Jiménez-Fàbrega
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Facultat de Ciencies Mèdiques, Universitat de Barcelona, Spain
| | - Alfredo Bardají
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
- Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain
| | - Bjarne Madsen Hardig
- Department of Clinical Sciences, Helsingborg, Medical Faculty, Lund University, Sweden
| | - Youcef Azeli
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Sistema d’Emergències Mèdiques de Catalunya, Spain
- Emergency Department, Sant Joan University Hospital, Reus, Spain
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5
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Zaki HA, Iftikhar H, Shaban EE, Najam M, Alkahlout BH, Shallik N, Elnabawy W, Basharat K, Azad AM. The role of point-of-care ultrasound (POCUS) imaging in clinical outcomes during cardiac arrest: a systematic review. Ultrasound J 2024; 16:4. [PMID: 38265564 PMCID: PMC10808079 DOI: 10.1186/s13089-023-00346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/07/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cardiac arrest in hospital and out-of-hospital settings is associated with high mortality rates. Therefore, a bedside test that can predict resuscitation outcomes of cardiac arrest patients is of great value. Point-of-care ultrasound (POCUS) has the potential to be used as an effective diagnostic and prognostic tool during cardiac arrest, particularly in observing the presence or absence of cardiac activity. However, it is highly susceptible to "self-fulfilling prophecy" and is associated with prolonged cardiopulmonary resuscitation (CPR), which negatively impacts the survival rates of cardiac arrest patients. As a result, the current systematic review was created to assess the role of POCUS in predicting the clinical outcomes associated with out-of-hospital and in-hospital cardiac arrests. METHODS The search for scientific articles related to our study was done either through an electronic database search (i.e., PubMed, Medline, ScienceDirect, Embase, and Google Scholar) or manually going through the reference list of the relevant articles. A quality appraisal was also carried out with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2), and the prognostic test performance (sensitivity and sensitivity) was tabulated. RESULTS The search criteria yielded 3984 articles related to our topic, of which only 22 were eligible for inclusion. After reviewing the literature, we noticed a wide variation in the definition of cardiac activity, and the statistical heterogeneity was high; therefore, we could not carry out meta-analyses. The tabulated clinical outcomes based on initial cardiac rhythm and definitions of cardiac activity showed highly inconsistent results. CONCLUSION POCUS has the potential to provide valuable information on the management of cardiac arrest patients; however, it should not be used as the sole predictor for the termination of resuscitation efforts.
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Affiliation(s)
- Hany A Zaki
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Haris Iftikhar
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar.
| | - Eman E Shaban
- Cardiology, Al Jufairi Diagnosis and Treatment, Doha, Qatar
| | - Mavia Najam
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Nabil Shallik
- Anesthesia Department, IT Deputy Chair, HMC, Doha, Qatar
| | - Wael Elnabawy
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Kaleem Basharat
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
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6
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Gorgone M, Bartholow T, Maximous SI. Dynamic Changes in Clinical Status: The Importance of Reassessment with Point-of-Care Ultrasound. Ann Am Thorac Soc 2024; 21:158-164. [PMID: 38156896 DOI: 10.1513/annalsats.202307-636cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/10/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Matthew Gorgone
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Tanner Bartholow
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephanie I Maximous
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, and
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7
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Osterwalder J, Polyzogopoulou E, Hoffmann B. Point-of-Care Ultrasound-History, Current and Evolving Clinical Concepts in Emergency Medicine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2179. [PMID: 38138282 PMCID: PMC10744481 DOI: 10.3390/medicina59122179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Point-of-care ultrasound (PoCUS) has become an indispensable standard in emergency medicine. Emergency medicine ultrasound (EMUS) is the application of bedside PoCUS by the attending emergency physician to assist in the diagnosis and management of many time-sensitive health emergencies. In many ways, using PoCUS is not only the mere application of technology, but also a fusion of already existing examiner skills and technology in the context of a patient encounter. EMUS practice can be defined using distinct anatomy-based applications. The type of applications and their complexity usually depend on local needs and resources, and practice patterns can vary significantly among regions, countries, or even continents. A different approach suggests defining EMUS in categories such as resuscitative, diagnostic, procedural guidance, symptom- or sign-based, and therapeutic. Because EMUS is practiced in a constantly evolving emergency medical setting where no two patient encounters are identical, the concept of EMUS should also be practiced in a fluid, constantly adapting manner driven by the physician treating the patient. Many recent advances in ultrasound technology have received little or no attention from the EMUS community, and several important technical advances and research findings have not been translated into routine clinical practice. The authors believe that four main areas have great potential for the future growth and development of EMUS and are worth integrating: 1. In recent years, many articles have been published on novel ultrasound applications. Only a small percentage has found its way into routine use. We will discuss two important examples: trauma ultrasound that goes beyond e-FAST and EMUS lung ultrasound for suspected pulmonary embolism. 2. The more ultrasound equipment becomes financially affordable; the more ultrasound should be incorporated into the physical examination. This merging and possibly even replacement of aspects of the classical physical exam by technology will likely outperform the isolated use of stethoscope, percussion, and auscultation. 3. The knowledge of pathophysiological processes in acute illness and ultrasound findings should be merged in clinical practice. The translation of this knowledge into practical concepts will allow us to better manage many presentations, such as hypotension or the dyspnea of unclear etiology. 4. Technical innovations such as elastography; CEUS; highly sensitive color Doppler such as M-flow, vector flow, or other novel technology; artificial intelligence; cloud-based POCUS functions; and augmented reality devices such as smart glasses should become standard in emergencies over time.
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Affiliation(s)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece;
| | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd., WCC2, Boston, MA 02215, USA
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8
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Chan B, Sieg S, Singh Y. Unveiling pseudo-pulseless electrical activity (pseudo-PEA) in ultrasound-integrated infant resuscitation. Eur J Pediatr 2023; 182:5285-5291. [PMID: 37725211 PMCID: PMC10746595 DOI: 10.1007/s00431-023-05199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
Point-of-care ultrasound (POCUS) holds immense potential to manage critically deteriorating infants within the neonatal intensive care unit (NICU) and is increasingly used in neonatal clinical practice worldwide. Recent ultrasound-based protocols such as the Sonographic Assessment of liFe-threatening Emergencies-Revised (SAFE-R) and Crashing Neonate Protocol (CNP) offer step-by-step guidance for diagnosing and addressing reversible causes of cardiorespiratory collapse. Traditionally, pulseless electrical activity (PEA) has been diagnosed solely based on absent pulses on clinical examination, disregarding myocardial activity. However, integrating POCUS into resuscitation unveils the concept of pseudo-PEA, where cardiac motion activity is observed visually on the ultrasound but fails to generate a detectable pulse due to inadequate cardiac output. Paradoxically, existing neonatal resuscitation protocols lack directives for identifying and effectively leveraging pseudo-PEA insights in infants, limiting their potential to enhance outcomes. Pseudo-PEA is extensively described in adult literature owing to routine POCUS use in resuscitation. This review article comprehensively evaluates the adult pseudo-PEA literature to glean insights adaptable to neonatal care. Additionally, we propose a simple strategy to integrate POCUS during neonatal resuscitation, especially in infants who do not respond to routine measures. CONCLUSION Pseudo-PDA is a newly recognized diagnosis in infants with the use of POCUS during resuscitation. This article highlights the importance of cross-disciplinary learning in tackling emerging challenges within neonatal medicine. WHAT IS KNOWN • Point-of-Care ultrasound (POCUS) benefits adult cardiac arrest management, particularly in distinguishing true Pulseless Electrical Activity (PEA) from pseudo-PEA. • Pseudo-PEA is when myocardial motion can be seen on ultrasound but fails to generate palpable pulses or sustain circulation despite evident cardiac electrical activity. WHAT IS NEW • Discuss recognition and management of pseudo-PEA in infants. • A proposed algorithm to integrate POCUS into active neonatal cardiopulmonary resuscitation (CPR) procedures.
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Affiliation(s)
- Belinda Chan
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, UT, 84108, USA
- Department of Radiology and Imaging Science, University of Utah, Salt Lake City, UT, 84108, USA
| | - Susan Sieg
- Intermountain Healthcare, Salt Lake City, UT, 84108, USA
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, 11175 Coleman Pavilion, Campus Street, Loma Linda, CA, 92354, USA.
- Department of Pediatrics, Division of Neonatology, University of Southern California, Los Angeles, CA, 90089, USA.
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9
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Wong A, Vignon P, Robba C. How I use ultrasound in cardiac arrest. Intensive Care Med 2023; 49:1531-1534. [PMID: 38010384 DOI: 10.1007/s00134-023-07249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/08/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK.
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit and Inserm CIC 1435, Dupuytren Teaching Hospital, Limoges, France
| | - Chiara Robba
- Dipartimento Di Scienze Chirurgiche E Diagnostiche, University of Genoa, Genoa, Italy
- IRCCS, Policlinico San Martino, Genoa, Italy
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10
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Sabogal RC. Exploring the Applicability of Pre-Anesthetic Cardiac POCUS in Unexpected Conditions: Could it be Helpful? POCUS JOURNAL 2023; 8:237-242. [PMID: 38099178 PMCID: PMC10721308 DOI: 10.24908/pocus.v8i2.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Formal preoperative echocardiography has traditionally been recommended when there is substantial cardiovascular disease without recent follow up, unexplained dyspnea, a functional class less than 4 METS or a Duke Activity Status Index less than 34. However, it is important to note that certain patients may present with a variety of cardiac abnormalities due to their preexisting condition or multiple treatments, and these individuals warrant consideration. The objective of pre-anesthetic cardiac POCUS is to provide clinical information in a timely manner. Although it does not aim to replace conventional echocardiography, cardiac POCUS can undoubtedly assist anesthesia practitioners in identifying asymptomatic and potentially hazardous conditions, allowing for more accurate risk allocation and individualized patient care.
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Affiliation(s)
- Rodolfo C Sabogal
- Department of Anesthesiology and Critical Care, Universidad de Cartagena, Universidad de AntioquiaCartagenaColombia
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11
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Kornelsen J, Ho H, Robinson V, Frenkel O. Rural family physician use of point-of-care ultrasonography: experiences of primary care providers in British Columbia, Canada. BMC PRIMARY CARE 2023; 24:183. [PMID: 37684568 PMCID: PMC10486031 DOI: 10.1186/s12875-023-02128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND In British Columbia (BC), rural and remote areas lack proximal access to radiographic services. Poor access to radiographic services in rural settings presents a challenge to timely diagnosis and screening across many disease states and healthy pregnancies. As a solution to the lack of access to radiographic services in rural settings, the Rural Coordination Centre of BC (RCCbc) supported rural Family Physicians (FPs) wishing to use PoCUS through the Intelligent Network for PoCUS (IN PoCUS) program. This study evaluates FPs' experience and use of PoCUS in their clinical practice. METHODS This qualitative study conducted in-depth virtual interviews with 21 FPs across rural BC. The interview asked participants' motivation to participate in the RCCbc program, the type of training they received, their current use of PoCUS, their experience with the technology, and their experience interacting with specialists in regional centres. Thematic analysis of findings was undertaken. RESULTS This study used Rogers' framework on the five elements of diffusion of innovation to understand the factors that impede and enable the adoption of PoCUS in rural practice. Rural FPs in this study differentiated PoCUS from formal imaging done by specialists. The adoption of PoCUS was viewed as an extension of physical exams and was compatible with their values of providing generalist care. This study found that the use of PoCUS provided additional information that led to better clinical decision-making for triage and allowed FPs to determine the urgency for patient referral and transport to tertiary hospitals. FPs also reported an increase in job satisfaction with PoCUS use. Some barriers to using PoCUS included the time needed to be acquainted with the technology and learning how to integrate it into their clinical flow in a seamless manner. CONCLUSION This study has demonstrated the importance of PoCUS in improving patient care and facilitating timely diagnosis and treatment. As the use of PoCUS among FPs is relatively new in Canada, larger infrastructure support such as improving billing structures, long-term subsidies, educational opportunities, and a quality improvement framework is needed to support the use of PoCUS among rural FPs.
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Affiliation(s)
- Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Hilary Ho
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Virginia Robinson
- Rural Coordination Centre of British Columbia, 1665 West Broadway, Vancouver, BC, V6J 1X1, Canada
| | - Oron Frenkel
- Providence Health Care, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
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12
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Weber MD, Lim JKB, Ginsburg S, Conlon T, Nishisaki A. Translating Guidelines into Practical Practice: Point-of-Care Ultrasound for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:385-406. [PMID: 36898781 DOI: 10.1016/j.ccc.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Point-of-care ultrasound (POCUS) is now transitioning from an emerging technology to a standard of care for critically ill children. POCUS can provide immediate answers to clinical questions impacting management and outcomes within this fragile population. Recently published international guidelines specific to POCUS use in neonatal and pediatric critical care populations now complement previous Society of Critical Care Medicine guidelines. The authors review consensus statements within guidelines, identify important limitations to statements, and provide considerations for the successful implementation of POCUS in the pediatric critical care setting.
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Affiliation(s)
- Mark D Weber
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Joel K B Lim
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Sarah Ginsburg
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Conlon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
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13
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Heinz ER, Keneally R, d'Empaire PP, Vincent A. Current status of point of care ultrasonography for the perioperative care of trauma patients. Curr Opin Anaesthesiol 2023; 36:168-175. [PMID: 36550092 DOI: 10.1097/aco.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The incorporation of point of care ultrasound into the field of anesthesiology and perioperative medicine is growing at rapid pace. The benefits of this modality align with the acuity of patient care and decision-making in anesthetic care of a trauma patient. RECENT FINDINGS Cardiac ultrasound can be used to diagnose cardiac tamponade or investigate the inferior vena cava to assess volume status in patients who may suffer from hemorrhagic shock. Thoracic ultrasound may be used to rapidly identify pneumothorax or hemothorax in a patient suffering chest wall trauma. In addition, investigators are exploring the utility of ultrasonography in traumatic airway management and elevated intracranial pressure. In addition, the utility of gastric ultrasound on trauma patients is briefly discussed. SUMMARY Incorporation of point of care ultrasound techniques into the practice of trauma anesthesiology is important for noninvasive, mobile and expeditious assessment of trauma patients. In addition, further large-scale studies are needed to investigate how point of care ultrasound impacts outcomes in trauma patients.
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Affiliation(s)
- Eric R Heinz
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
| | - Ryan Keneally
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
| | - Pablo Perez d'Empaire
- Department of Anesthesiology and Pain Medicine, Department of Anesthesia, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
| | - Anita Vincent
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
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D’Andrea A, Del Giudice C, Fabiani D, Caputo A, Sabatella F, Cante L, Palermi S, Desiderio A, Tagliamonte E, Liccardo B, Russo V. The Incremental Role of Multiorgan Point-of-Care Ultrasounds in the Emergency Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2088. [PMID: 36767456 PMCID: PMC9915087 DOI: 10.3390/ijerph20032088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Point-of-care ultrasonography (POCUS) represents a goal-directed ultrasound examination performed by clinicians directly involved in patient healthcare. POCUS has been widely used in emergency departments, where US exams allow physicians to make quick diagnoses and to recognize early life-threatening conditions which require prompt interventions. Although initially meant for the real-time evaluation of cardiovascular and respiratory pathologies, its use has been extended to a wide range of clinical applications, such as screening for deep-vein thrombosis and trauma, abdominal ultrasonography of the right upper quadrant and appendix, and guidance for invasive procedures. Moreover, recently, bedside ultrasounds have been used to evaluate the fluid balance and to guide decongestive therapy in acutely decompensated heart failure. The aim of the present review was to discuss the most common applications of POCUS in the emergency setting.
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Affiliation(s)
- Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Carmen Del Giudice
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Dario Fabiani
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Adriano Caputo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesco Sabatella
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luigi Cante
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Alfonso Desiderio
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Ercole Tagliamonte
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Biagio Liccardo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Vincenzo Russo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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15
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Riendeau Beaulac G, Teran F, Lecluyse V, Costescu A, Belliveau M, Desjardins G, Denault A. Transesophageal Echocardiography in Patients in Cardiac Arrest: The Heart and Beyond. Can J Cardiol 2023; 39:458-473. [PMID: 36621564 DOI: 10.1016/j.cjca.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
Point of care ultrasound involves different ultrasound modalities and is useful to assist management in emergent clinical situations such as cardiac arrest. The use of point of care ultrasound in cardiac arrest has mainly been described using transthoracic echocardiography as a diagnostic and as a prognostic tool. However, cardiac evaluation using transthoracic echocardiography might be challenging because of patient-related or technical factors. Furthermore, its use during pulse check pauses has been associated with delays in chest compression resumption. Transesophageal echocardiography (TEE) overcomes these limitations by providing reliable and continuous imaging of the heart without interfering with cardiopulmonary resuscitation. In this narrative review we describe the role of TEE during cardiopulmonary resuscitation in 4 different applications: (1) chest compression quality feedback; (2) rhythm characterization; (3) diagnosis of reversible causes; and (4) procedural guidance. Considering its limitations, we propose an algorithm for the integration of TEE in patients with cardiac arrest with a focus on these 4 applications and extend its use to extracardiac applications.
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Affiliation(s)
- Geneviève Riendeau Beaulac
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Felipe Teran
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Vincent Lecluyse
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Adrian Costescu
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Belliveau
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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16
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Haskings EM, Eissa M, Allard RV, MirGhassemi A, McFaul CM, Miller EC. Point-of-care ultrasound use in emergencies: what every anaesthetist should know. Anaesthesia 2023; 78:105-118. [PMID: 36449358 DOI: 10.1111/anae.15910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 12/05/2022]
Abstract
Point-of-care ultrasound has been embraced by anaesthetists as an invaluable tool for rapid diagnosis of haemodynamic instability, to ensure procedural safety and monitor response to treatments. Increasingly available, affordable and portable, with emerging evidence of improved patient outcomes, point-of-care ultrasound has become a valuable tool in the emergency setting. This state-of-the-art review describes the feasibility of point-of-care ultrasound practice, training and maintenance of competence. It also describes the many uses of point-of-care ultrasound for the anaesthetist and describes the most salient point-of-care ultrasound views for anaesthetic emergencies including: undifferentiated shock; hypoxemia; and trauma. Procedural safety is also discussed in addition to relevant important governance aspects. Cardiac function should be assessed using the parasternal long axis, parasternal short basal/mid-papillary/apical, apical four chamber and subcostal four chamber views, and should include a visual estimation of global left ventricular ejection fraction. Other cardiovascular conditions that can be identified using point-of-care ultrasound include: pericardial effusion; cardiac tamponade; and pulmonary embolism. Pulmonary emergency conditions that can be diagnosed using point-of-care ultrasound include pneumothorax; pleural effusion; and interstitial syndrome. The extended focused assessment with sonography for trauma examination may of value in patients who are hypotensive in order to identify intra-abdominal haemorrhage, pneumothoraces and haemothoraces.
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Affiliation(s)
- E M Haskings
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M Eissa
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - R V Allard
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - A MirGhassemi
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - C M McFaul
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - E C Miller
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
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17
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Thota RS, Ramkiran S, Ramanjulu R. Time to FOCUS - 'Palliative Medicine Point-of-Care Ultrasound'. Indian J Palliat Care 2023; 29:36-45. [PMID: 36846289 PMCID: PMC9945239 DOI: 10.25259/ijpc_274_2022] [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: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
Point-of-care diagnosis has become the need of the hour and along with its guided interventions, ultrasound could be utilised bedside in a palliative care patient. Point-of-care ultrasound (POCUS) in palliative care medicine is fast emerging and has varied applications ranging from performing bedside diagnostic evaluation to the performance of interventional paracentesis, thoracocentesis and chronic pain interventions. Handheld ultrasound devices have transformed the application of POCUS and should revolutionise the future of home-based palliative care. Palliative care physicians should be enabled to carry out bedside ultrasounds at home care and hospice setting for achieving rapid symptom relief. The aim of POCUS in palliative care medicine should be adequate training of palliative care physicians, transforming the applicability of this technology to OPD as well as community driven to achieve home outreach. The goal is towards empowering technology by reaching out to the community rather than the terminally ill patient transported for the hospital admission. Palliative care physicians should receive mandatory training in POCUS to enable diagnostic proficiency and early triaging. The inclusion of ultrasound machine in an outpatient palliative care clinic brings about value addition in rapid diagnosis. Limiting POCUS application to certain selected sub-specialities such as emergency medicine, internal medicine and critical care medicine should be overcome. This would need acquiring higher training as well as improvised skill sets to perform bedside interventions. Ultrasonography competency among palliative care providers proposed as palliative medicine point-of-care ultrasound (PM-POCUS) could be achieved by imparting dedicated POCUS training within the core curriculum.
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Affiliation(s)
| | - Seshadri Ramkiran
- Department of Anaesthesia and Critical Care, HCG Cancer Hospital, Bengaluru, Karnataka, India
| | - Raghavendra Ramanjulu
- Department of Pain and Palliative Care, Aster Hospitals, Bengaluru, Karnataka, India
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Cassara CM, Long MT, Dollerschell JT, Chae F, Hall DJ, Demiralp G, Stampfl MJ, Bernardoni B, McCarthy DP, Glazer JM. Extracorporeal Cardiopulmonary Resuscitation: A Narrative Review and Establishment of a Sustainable Program. Medicina (B Aires) 2022; 58:medicina58121815. [PMID: 36557017 PMCID: PMC9781756 DOI: 10.3390/medicina58121815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
The rates of survival with functional recovery for out of hospital cardiac arrest remain unacceptably low. Extracorporeal cardiopulmonary resuscitation (ECPR) quickly resolves the low-flow state of conventional cardiopulmonary resuscitation (CCPR) providing valuable perfusion to end organs. Observational studies have shown an association with the use of ECPR and improved survivability. Two recent randomized controlled studies have demonstrated improved survival with functional neurologic recovery when compared to CCPR. Substantial resources and coordination amongst different specialties and departments are crucial for the successful implementation of ECPR. Standardized protocols, simulation based training, and constant communication are invaluable to the sustainability of a program. Currently there is no standardized protocol for the post-cannulation management of these ECPR patients and, ideally, upcoming studies should aim to evaluate these protocols.
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Affiliation(s)
- Chris M. Cassara
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
- Correspondence: ; Tel.: +1-608-263-8100
| | - Micah T. Long
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - John T. Dollerschell
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Floria Chae
- Department of Anesthesiology, Ohio State University Wexner Medical Center, 370 W. 9th Ave., Columbus, OH 43210, USA
| | - David J. Hall
- Department of Surgery, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Gozde Demiralp
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Matthew J. Stampfl
- Department of Emergency Medicine, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Brittney Bernardoni
- Department of Emergency Medicine, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Daniel P. McCarthy
- Department of Surgery, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
| | - Joshua M. Glazer
- Department of Emergency Medicine, University of Wisconsin Hospitals & Clinics, 600 Highland Ave., Madison, WI 53792, USA
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AKGÜL A. The use of ultrasonography to guide diagnosis and treatment in resuscitation in a case of arrest due to pulmonary embolism. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1069084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pulmonary embolism is one of the reversible causes of death. Simultaneous diagnostic procedures are beneficial for successfully resuscitating patients brought to the emergency department as an arrest after pulmonary embolism. Ultrasonography is one of the few diagnostic procedures to be performed on an unstable patient during resuscitation and is a direct guide for treatment. We followed the passage of the thrombus from the inferior vena cava to the right atrium in the ultrasonography performed simultaneously with the resuscitation of the 76-year-old male patient who was brought to the hospital with arrest, and we started thrombolytic therapy simultaneously with resuscitation. Thrombus enlargement was observed in the right atrium. The patient who did not respond to resuscitation died. Although the causes of reversible arrest are known, there may be uncertainties in diagnostic procedures and treatment during resuscitation. Classical resuscitation practice may be insufficient to solve reversible problems such as pulmonary embolism. Although there are reservations about the inclusion of point-of-care ultrasound in resuscitation, it can play a life-saving role.
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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]
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21
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Chu SE, Chang CJ, Chen HA, Chiu YC, Huang CY, Pei-Chuan Huang E, Hsieh MJ, Chiang WC, Huei-Ming Ma M, Sun JT. Core Ultrasound in REsuscitation (CURE): A Novel Protocol for Ultrasound-Assistant Life Support via Application of Both Transesophageal and Transthoracic Ultrasound. Resuscitation 2022; 173:1-3. [DOI: 10.1016/j.resuscitation.2022.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 01/01/2023]
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