Variability in Interpretation of Cardiac Standstill Among Physician Sonographers

Hu, Kevin; Gupta, Nachi; Teran, Felipe; Saul, Turandot; Nelson, Bret P.; Andrus, Phillip

doi:10.1016/j.annemergmed.2017.07.476

Cited by 42 publications

(18 citation statements)

References 13 publications

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“…97 However, there are significant concerns with interrater variability in image interpretation and potential interference of ultrasonography with CPR. 98 End-tidal carbon dioxide values less than 10 mm Hg after 20 minutes of CPR are also strongly associated with poor outcomes. 99 However, studies regarding point-of-care cardiac ultrasonography and end-tidal carbon dioxide should be interpreted carefully because blinding was rarely performed and the findings described might reflect a self-fulfilling prophecy where resuscitation is terminated based on these specific findings.…”

Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

679

535

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IMPORTANCE In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. OBSERVATIONS In-hospital cardiac arrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital cardiac arrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiac arrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiac arrest include chest compressions, ventilation, early defibrillation, when applicable, and immediate attention to potentially reversible causes, such as hyperkalemia or hypoxia. There is limited evidence to support more advanced treatments. Post–cardiac arrest care is focused on identification and treatment of the underlying cause, hemodynamic and respiratory support, and potentially employing neuroprotective strategies (eg, targeted temperature management). Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the Post–cardiac arrest period. Withdrawal of care in the absence of definite prognostic signs both during and after cardiac arrest should be avoided. Hospitals are encouraged to participate in national quality-improvement initiatives. CONCLUSIONS AND RELEVANCE An estimated 290 000 in-hospital cardiac arrests occur each year in the United States. However, there is limited evidence to support clinical decision making. An increased awareness with regard to optimizing clinical care and new research might improve outcomes.

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Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

679

535

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“…In addition, by design and due to logistic issues, we did not study chamber size abnormalities, cardiac standstill, or determination of cardiac arrest. International recommendations have been made for the use of FOCUS in cardiac arrest; while feasibility of using FOCUS in cases of pediatric cardiac arrest has been published, adult studies have noted challenges in agreement of interpretation of cardiac standstill among different levels of providers [14–16].…”

Section: Discussionmentioning

confidence: 99%

Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists

et al. 2018

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BackgroundFocused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition.MethodsPEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms.ResultsEight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19–90.8) and specificity of 100.0% (95% CI 91.1–100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67–97.33) and specificity of 98.1% (95% CI 88.42–99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7–88.8) and specificity 75% (95% CI 67.0–81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0–85.0) and specificity 94.4% (95% CI 89.0–97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows’ interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59–0.73) for effusion and 0.31 (95% CI 0.24–0.38) for function among the fellows.ConclusionNovice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. However, they made real-time interpretation errors and likely need further training to incorporate real-time image acquisition and interpretation into their practice.Electronic supplementary materialThe online version of this article (10.1186/s13089-018-0113-4) contains supplementary material, which is available to authorized users.

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“…Can the procedure be used to predict outcome? Echocardiography typically requires pauses in chest compressions, [100][101][102][103] although the use of a protocol can reduce the duration of these pauses. 103,104 Practical difficulties in the use of ultrasound in infants and children (that do not occur in adults) include small patient size that may limit access to some views, particularly if other monitoring pads are on the chest.…”

Section: Summary Of Evidencementioning

confidence: 99%

Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Maconochie¹,

Aickin²,

Hazinski³

et al. 2020

Circulation

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation. Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children.

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Variability in Interpretation of Cardiac Standstill Among Physician Sonographers

Cited by 42 publications

References 13 publications

In-Hospital Cardiac Arrest

In-Hospital Cardiac Arrest

Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists

Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

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