Point-of-Care Emergency Ultrasonography in Non-Traumatic Cardiac Arrest and Near-Arrest Emergency Patients; A Pilot Trial

Abstract

INTRODUCTION: In this study, we evaluated the applicability and interpretation of point-of-care emergency ultrasound (POCEUS) performed by an emergency physician (EP) in non-traumatic adult cardiac arrest and near-arrest patients at presentation to the Emergency Department (ED). METHODs: POCEUS was performed in 5 steps on 73 adults to assess; 1. Qualitative global cardiac function, cardiac chambers and presence of pericardial effusion; 2. Presence of pleural sliding, B-lines, A-lines or consolidation on anterior-superior; 3. Presence of an abdominal aorta aneurysm and pelvic free fluid; 4. Presence of pleural effusion, consolidation, free fluid on lateral-inferior; 5. Qualitative width and collapsibility of the inferior vena cava. A fulfilled checklist and real-time images of ultrasonography were sent by WhatsApp to the head of the study to generate the evidence and collect the data. The process of patient care, in-hospital diagnosis and survival were retrieved from digital hospital records. This prospective multicenter sample study was conducted from November 16, 2015, to January 5, 2016. REsUlTs: The most common findings of POCEUS were performed and interpreted to have a first prediction of patients' acute clinic problem by EPs were compatible with global systolic dysfunction (n = 16, 22.9%), pulmonary edema (n = 17, 23.3%), pulmonary embolus (n = 6, 8.2%), distributive/hypovolemic shock (n = 12, 16.4%), cardiac tamponade or pericardial effusion (n = 5, 6.8%), and pneumonia (n = 31, 42.5%) at presentation. The kappa correlation coefficient value of the POCEUS at presentation versus the final, traditional clinical diagnosis of the admitted ward, was 0.773 (95% CI, 0.747-0.892; p = 0.064, McNemar). CONClUsIONs: POCEUS performed by an EP at presentation had a good agreement between in qualitative prediction of the first differential diagnosis in life-threatened patients and the last diagnosis obtained during hospitalization. Furthermore, this study showed the requirement of evidence in comparison of measurements to the qualitative manner and new descriptive processes in POCEUS for unexplained situations and questions.

Diagnostic performance of point-of-use ultrasound of resuscitation outcomes: A systematic review and meta-analysis of 3265 patients

“…The second most useful application of echocardiography during CPR is that of determining the probability of a successful resuscitation. In this situation echocardiography is used to identify spontaneous cardiac movement [ 11 , 12 ]. The meta-analysis conducted by Tsou et al [ 11 ] has revealed that spontaneous cardiac movement possesses a sensitivity and specificity of 95% and 80% (95% confidence interval [CI] 0.72–0.99, and 0.63–0.91, respectively) for predicting return of spontaneous circulation (ROSC) during cardiac arrest, with a positive and negative likelihood ratio of 4.8 and 0.06 (95% CI 2.5–9.4, and 0.01–0.39, respectively).…”