EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) SHORT VERSION

OBJECTIVE

 To evaluate the evidence and produce a summary and recommendations for the most common heart and lung point-of-care ultrasound (PoCUS).

METHODS

 We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendations were produced, including assigning levels of evidence (LoE) and grading of recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement of the summary and recommendation for each question (using a 5-point Likert scale), which was approved in the case of a level of agreement of greater than 75 %. A level of agreement was defined as a summary of "strongly agree" and "agree" on the Likert scale responses.

FINDINGS AND RECOMMENDATIONS

 One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1), the remaining 9 questions achieved broad agreement with an assigned LoE of 4 and a weak GRADE recommendation (question 2), three achieved an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8) and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10).

CONCLUSION

 These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings.

EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) LONG VERSION

AIMS

 To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS).

METHODS

 We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of "strongly agree" and "agree" on the Likert scale responses.

FINDINGS AND RECOMMENDATIONS

 One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10).

CONCLUSION

 These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings.

Agreement of emergency physician-performed ultrasound versus RADiology-performed UltraSound for cholelithiasis or cholecystitis: a systematic review

Cholecystitis secondary to gallstone migration is the most common suspected diagnosis for right upper quadrant pain in emergency departments, with radiology-performed ultrasound (RADUS) being the main diagnostic tool. The primary aim of this review was to assess the ability of emergency physicians to perform emergency ultrasound (EUS) compared to RADUS to diagnose cholelithiasis and cholecystitis. A systematic search was performed using Embase, Central (Cochrane library), Web of Science, MEDLINE, Google Scholar, prospective trial registries, and OpenSIGLE databases as well as hand-search of articles. Two physicians independently selected the articles. Assessment of methodological quality was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Clinical and methodological heterogeneity were qualitatively reported and discussed. Seven prospective studies were selected involving a total of 1061 subjects undergoing EUS. The included studies all used RADUS as the reference standard and emergency physician-performed EUS as the index test. Included studies mostly reported diagnostic accuracy for cholelithiasis diagnosis whereas only one study mentioned diagnostic accuracy for cholecystitis. Clinical and methodological heterogeneity between included studies prevented a meta-analysis. This review shows there is good agreement between EUS and RADUS to assess the gallbladder for cholelithiasis and therefore supports its use by emergency physicians for that matter. Nevertheless, this work identified clinical and methodological heterogeneity along with a poor description EUS operators' experience. In the future, larger studies should include a larger population of EUS operators, specify their background, and compare EUS to the final diagnosis to evaluate performances for gallbladder diagnostic accuracy.

Adult respiratory distress syndrome caused by 2009 H1N1 influenza during pregnancy: success of ECMO for both the mother and the child

Extracorporeal membrane oxygenation (ECMO) is a technique that provides support to selected patients with severe respiratory failure. During the 2009 H1N1 influenza infection outbreak, ECMO was used with a good impact on survival for pregnant women, who are at higher risk of H1N1 influenza infection. However, there is little information about the survival of fetus post-ECMO therapy in the literature. We present a case report of a pregnant patient with severe adult respiratory distress syndrome secondary to 2009 H1N1 influenza treated with ECMO. The outcome was good both for the mother and her fetus. At 1-year follow-up, her child had no neurological or clinical abnormalities. We conclude that ECMO can be used safely during pregnancy with a good neurological and clinical outcome for the fetus.