1
|
Hafner C, Manschein V, Klaus DA, Schaubmayr W, Tiboldi A, Scharner V, Gleiss A, Thal B, Krammel M, Hamp T, Willschke H, Hermann M. Live stream of prehospital point-of-care ultrasound during cardiopulmonary resuscitation - A feasibility trial. Resuscitation 2024; 194:110089. [PMID: 38110144 DOI: 10.1016/j.resuscitation.2023.110089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Current resuscitation guidelines recommend that skilled persons could use ultrasound to detect reversible causes during cardiopulmonary resuscitation (CPR) where the examination can be safely integrated into the Advanced Life Support (ALS) algorithm. However, in a prehospital setting performing and rapidly interpreting ultrasound can be challenging for physicians. Implementing remote, expert-guided, and real-time transmissions of ultrasound examinations offers the opportunity for tele-support, even during an out-of-hospital cardiac arrest (OHCA). The aim of this feasibility study was to evaluate the impact of tele-supported ultrasound in ALS on hands-off time during an OHCA. METHODS In an urban setting, physicians performed point-of-care ultrasound (POCUS) on patients during OHCA using a portable device, either with tele-support (n = 30) or without tele-support (n = 12). Where tele-support was used, the ultrasound image was transmitted via a remote real-time connection to an on-call specialist in anaesthesia and intensive care medicine with an advanced level of critical care ultrasound expertise. The primary safety endpoint of this study was to evaluate whether POCUS can be safely integrated into the algorithm, and to provide an analysis of hands-off time before, during, and after POCUS during OHCA. RESULTS In all 42 cases it was possible to perform POCUS during regular rhythm analyses, and no additional hands-off time was required. In 40 of these 42 cases, the physicians were able to perform POCUS during a single regular rhythm analysis, with two periods required only in two cases. The median hands-off time during these rhythm analyses for POCUS with tele-support was 10 (8-13) seconds, and 11 (9-14) seconds for POCUS without tele-support. Furthermore, as a result of POCUS, in a quarter of all cases the physician on scene altered their diagnosis of the primary suspected cause of cardiac arrest, leading to a change in treatment strategy. CONCLUSIONS This feasibility study demonstrated that POCUS with tele-support can be safely performed during OHCA in an urban environment. Trial Registration (before patient enrolment): ClinicalTrials.gov, NCT04817475.
Collapse
Affiliation(s)
- C Hafner
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Ludwig Boltzmann Institute Digital Health and Patient Safety, Waehringer Straße 104/10, 1180 Vienna, Austria
| | - V Manschein
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - D A Klaus
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - W Schaubmayr
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A Tiboldi
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - V Scharner
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A Gleiss
- Centre for Medical Data Science, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - B Thal
- Emergency Medical Service Vienna, Radetzkystrasse 1, 1030 Vienna, Austria
| | - M Krammel
- Emergency Medical Service Vienna, Radetzkystrasse 1, 1030 Vienna, Austria; PULS - Austrian Cardiac Arrest Awareness Association, Lichtenthaler Gasse 4/1/R03, 1090 Vienna, Austria
| | - T Hamp
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Emergency Medical Service Vienna, Radetzkystrasse 1, 1030 Vienna, Austria
| | - H Willschke
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Ludwig Boltzmann Institute Digital Health and Patient Safety, Waehringer Straße 104/10, 1180 Vienna, Austria
| | - M Hermann
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Ludwig Boltzmann Institute Digital Health and Patient Safety, Waehringer Straße 104/10, 1180 Vienna, Austria.
| |
Collapse
|
2
|
Hafner C, Scharner V, Hermann M, Metelka P, Hurch B, Klaus DA, Schaubmayr W, Wagner M, Gleiss A, Willschke H, Hamp T. Eye-tracking during simulation-based echocardiography: a feasibility study. BMC Med Educ 2023; 23:490. [PMID: 37393288 DOI: 10.1186/s12909-023-04458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Due to the technical progress point-of-care ultrasound (POCUS) is increasingly used in critical care medicine. However, optimal training strategies and support for novices have not been thoroughly researched so far. Eye-tracking, which offers insights into the gaze behavior of experts may be a useful tool for better understanding. The aim of this study was to investigate the technical feasibility and usability of eye-tracking during echocardiography as well as to analyze differences of gaze patterns between experts and non-experts. METHODS Nine experts in echocardiography and six non-experts were equipped with eye-tracking glasses (Tobii, Stockholm, Sweden), while performing six medical cases on a simulator. For each view case specific areas of interests (AOI) were defined by the first three experts depending on the underlying pathology. Technical feasibility, participants' subjective experience on the usability of the eye-tracking glasses as well as the differences of relative dwell time (focus) inside the areas of interest (AOI) between six experts and six non-experts were evaluated. RESULTS Technical feasibility of eye-tracking during echocardiography was achieved with an accordance of 96% between the visual area orally described by participants and the area marked by the glasses. Experts had longer relative dwell time in the case specific AOI (50.6% versus 38.4%, p = 0.072) and performed ultrasound examinations faster (138 s versus 227 s, p = 0.068). Furthermore, experts fixated earlier in the AOI (5 s versus 10 s, p = 0.033). CONCLUSION This feasibility study demonstrates that eye-tracking can be used to analyze experts and non-experts gaze patterns during POCUS. Although, in this study the experts had a longer fixation time in the defined AOIs compared to non-experts, further studies are needed to investigate if eye-tracking could improve teaching of POCUS.
Collapse
Affiliation(s)
- Christina Hafner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Vincenz Scharner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Martina Hermann
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Philipp Metelka
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Benedikt Hurch
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Daniel Alexander Klaus
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Wolfgang Schaubmayr
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Harald Willschke
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Thomas Hamp
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
- Emergency Medical Service Vienna, Radetzkystraße 1, 1030, Vienna, Austria.
| |
Collapse
|
3
|
Hermann M, Hafner C, Scharner V, Hribersek M, Maleczek M, Schmid A, Schaden E, Willschke H, Hamp T. Remote real-time supervision of prehospital point-of-care ultrasound: a feasibility study. Scand J Trauma Resusc Emerg Med 2022; 30:23. [PMID: 35331304 PMCID: PMC8944068 DOI: 10.1186/s13049-021-00985-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although prehospital point-of-care ultrasound (POCUS) is gaining in importance, its rapid interpretation remains challenging in prehospital emergency situations. The technical development of remote real-time supervision potentially offers the possibility to support emergency medicine providers during prehospital emergency ultrasound. The aim of this study was to assess the feasibility of live data transmission and supervision of prehospital POCUS in an urban environment and so to improve patients’ safety. Methods Emergency doctors with moderate ultrasound experience performed prehospital POCUS in emergency cases (n = 24) such as trauma, acute dyspnea or cardiac shock using the portable ultrasound device Lumify™. The ultrasound examination was remotely transmitted to an emergency ultrasound expert in the clinic for real-time supervision via a secure video and audio connection. Technical feasibility as well as quality of communication and live stream were analysed. Results Prehospital POCUS with remote real-time supervision was successfully performed in 17 patients (71%). In 3 cases, the expert was not available on time and in 1 case remote data transmission was not possible due to connection problems. In 3 cases tele-supervision was restricted to video only and no verbal communication was possible via the device itself due to power saving mode of the tablet. Conclusion Remote real-time supervision of prehospital POCUS in an urban environment is feasible most of the time with excellent image and communication quality. Trial registration: ClinicalTrials Number NCT04612816. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00985-0.
Collapse
Affiliation(s)
- Martina Hermann
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Christina Hafner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Vincenz Scharner
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Mojca Hribersek
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Mathias Maleczek
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Andreas Schmid
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Schaden
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Harald Willschke
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Digital Health and Patient Safety, Vienna, Austria
| | - Thomas Hamp
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
4
|
Scharner V, Hasieber L, Sönnichsen A, Mann E. Efficacy and safety of Z-substances in the management of insomnia in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr 2022; 22:87. [PMID: 35100976 PMCID: PMC9887772 DOI: 10.1186/s12877-022-02757-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/28/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Z-drugs are usually prescribed as first line pharmacological therapy for insomnia. However, the benefits and risks of Z-drugs may differ for older adults. This systematic review investigated the available evidence on the efficacy and safety of Z-drugs in the management of insomnia in older adults. METHODS The Cochrane database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE were searched for systematic reviews, meta-analyses, controlled interventional and observational studies using a pre-formulated search term. The target population was older adults (≥65 years old) with insomnia. Studies were included if they reported efficacy and/or safety outcomes of the use of Z-drugs for the management of insomnia compared to placebo, usual or no treatment, or other pharmacological agents. RESULTS Eighteen studies were included (8 interventional and 10 observational studies). In short-term interventional studies, Z-drugs were similarly or better efficacious in improving both sleep and daytime parameters than placebo or other pharmacological treatments, while showing good results on measures of safety. However, in longer-term observational studies, Z-drugs significantly increased the risk for falls and fractures in comparison to no treatment or melatonin agonists. CONCLUSIONS Analyzing the evidence from short-term interventional studies, Z-drugs appear effective and safe for treatment of insomnia in older adults, but they may have unfavorable side effects when used for longer periods of time. We, therefore, recommend discontinuing Z-drugs, principally because of the high risk for falls and fractures. Nonetheless, quality and quantity of evidence are low. Due to the scarcity of data, especially concerning drug dependence after longer periods of treatment and due to the significantly increased risk for falls and fractures, further studies are needed to evaluate the benefit-risk profile of Z-drugs use in older patients, particularly for long-term use.
Collapse
Affiliation(s)
- Vincenz Scharner
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Lukas Hasieber
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Eva Mann
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
5
|
Scharner V. [Electronics in an obstetrical service]. Med Tekh 1981:59-60. [PMID: 7278564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|