Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: A prospective trial

Breitkreutz, Raoul; Price, Susanna; Steiger, Holger; Seeger, Florian; Ilper, H.; Ackermann, Hanns; Rudolph, Marcus; Uddin, Shahana; Weigand, Markus; Müller, Erwin W.; Walcher, Felix

doi:10.1016/j.resuscitation.2010.07.013

Cited by 396 publications

(250 citation statements)

References 36 publications

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“…Some articles and reviews have tried to clarify this point, and according to them, we can suggest three major indications: trauma (FAST or EFAST) [9,10], CPR (FEEL protocol) [11], and respiratory insufficiency (LUS) [2,12].…”

Section: Discussionmentioning

confidence: 99%

“…For example, the FAST is focused on the identification of free fluid in the pericardium, pleura, and peritoneum [9,10]; the FEEL is used in patients with cardiac arrest for no more than 10 seconds during the pulse check to search for reversible causes of cardiac arrest [11]; the RUSH goes rapidly through all the possible causes of shock [13].…”

Section: Discussionmentioning

confidence: 99%

“…Many out-of-hospital algorithms have been successfully tested by providers [9], including the focused assessment of sonography for trauma (FAST) and the Extended-FAST [9,10], the focused echocardiography in life support (FEEL) protocol during cardiopulmonary resuscitation (CPR) [11], the lung ultrasound (LUS) for the evaluation of respiratory insufficiency [2,12] and the rapid ultrasound for shock and hypotension (RUSH) protocol for hemodynamic instability [13]. The study of the abdominal aorta in a patient with abdominal pain and hemodynamic instability could be another important indication of pre-hospital US [2,14].…”

Section: Introductionmentioning

confidence: 99%

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Early identification of aortic dissection with pre-hospital ultrasound: a case report.

Zanatta¹,

Scorpiniti²,

Cianci³

2018

EJMCR

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BackgroundPoint of care ultrasound (POCUS) is considered an important diagnostic tool in the Emergency Department.Current developments in technology, the presence of portable ultrasound (US) machines, the improvement of the quality and resolution of the images, have increased the performance of US also in the pre-hospital setting [1,2].Several studies have demonstrated the feasibility and accuracy of pre-hospital US, performed either by physicians or paramedics, in many pre-hospital scenarios including land ambulances and helicopters of the Emergency Medical Services [3][4][5][6].Pre-hospital emergency US should be even more focused, rapid, and problem based than in-hospital point of care US, to reduce morbidity and improve outcomes for patients with life-threatening conditions. The integration of focused US with clinical signs improves diagnostic accuracy and provides crucial information to guide the diagnosis, the therapy and to improve the field triage, in order to deliver the patients to the most appropriate destination [7,8].Many out-of-hospital algorithms have been successfully tested by providers [9], including the focused assessment of sonography for trauma (FAST) and the Extended-FAST [9,10], the focused echocardiography in life support (FEEL) protocol during cardiopulmonary resuscitation (CPR) [11], the lung ultrasound (LUS) for the evaluation of respiratory insufficiency [2,12] and the rapid ultrasound for shock and hypotension (RUSH) protocol for hemodynamic instability [13]. The study of the abdominal aorta in a patient with abdominal pain and hemodynamic instability could be another important indication of pre-hospital US [2,14].The evaluation of the aorta is fast, and the dilation of the artery can be easily identified. On the contrary, the diagnosis of a dissection or of a broken aneurysm could be challenging and predicted only by the presence of indirect signs, such as a dilated aorta or the evidence of free fluid in the peritoneum. Nevertheless, when US is closely related to the patient's history and the clinical assessment, diagnostic accuracy can be extremely high [12][13][14][15].This case report analyses the feasibility and usefulness of pre-hospital US for the evaluation of the aorta in a hemodynamically unstable patient. Case PresentationWe present a case of a 50-year-old man who suddenly lost consciousness while he was working. He remained unconscious for a few minutes and then recovered slowly. Early identification of aortic dissection with pre-hospital ultrasound: a case report ABSTRACTBackground: Several studies have demonstrated the feasibility of pre-hospital ultrasound (US) in patients with trauma, cardiac arrest, and respiratory insufficiency. It should be rapid, problem based and the use of specific protocols (focused assessment of sonography for trauma, focused echocardiography in life support, and rapid ultrasound for shock and hypotension) prevents delays.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early identification of aortic dissection with pre-hospital ultrasound: a case report.

Zanatta¹,

Scorpiniti²,

Cianci³

2018

EJMCR

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“…Treatment for PEA arrest includes high-quality cardiopulmonary resuscitation (CPR), as well as identification and treatment of reversible causes of arrest (4). Ultrasonography during PEA arrest can differentiate underlying abnormalities, such as ventricular failure, pulmonary embolism, hypovolemia, and cardiac tamponade (5)(6)(7)(8)(9)(10), and may alter management of critically ill patients in up to 78% of cases (10). Additionally, ultrasonography provides prognostic information, as in cardiac standstill, which is associated with almost no likelihood of return of spontaneous circulation (11)(12)(13)(14)(15).…”

mentioning

confidence: 99%

Use of Point-of-Care Ultrasonography in Simulation-Based Advanced Cardiac Life Support Scenarios

Cha¹,

Gottschalk²,

Su³

et al. 2018

J Anesth Perioper Med

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Background: Ultrasonography is an effective tool for diagnosing potential reversible aetiologies of cardiac arrest. We developed an educational curriculum for critical care ultrasonography involving multiple sequential cardiac arrest simulation scenarios and assessed the efficacy of participants' performance. Methods: Didactic lectures and hands-on training sessions were provided before participants were divided into simulation teams for a series of five scenarios in which they were instructed to utilize ultrasonography during ongoing advanced cardiac life support (ACLS). Simulation sessions were videotaped and subsequently reviewed for extraction of parameters relating to ACLS adherence and performance of point-of-care ultrasonography examination. The primary outcome was duration of no-flow interval (NFI), the period during which chest compressions are halted and ultrasound examination is typically performed. We also collected data on NFI score (based on simulation team performance during NFI), time from arrest to first chest compressions, time from arrest to defibrillation, and other parameters describing team performance. Results: Fifty-five course participants comprised 12 simulation teams. For all participants, the average NFI was 22.2 s (95% CI, 19.1-25.2) during scenario 1, with declines in duration thereafter (P ≤ 0.004). In subsequent scenarios, an increasing proportion of NFI occurred within the interval of 10 s (P = 0.018). Conclusion: Simulation is an effective teaching modality for critical care ultrasonography. Novice ultrasound users can be taught to perform point-of-care ultrasonography effectively during simulated cardiopulmonary arrest in an ACLS-compliant manner, a finding that may have significant implications for the clinical management of in-hospital cardiac arrest. (Funded by the

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“…So, only a positive qualitative evaluation to critical US was attributed in our analysis. Although, in a recent study conducted on 88 patients suffering from cardiac arrest in a pre-hospital setting, caused by a not shockable rhythm, US has been feasible in 96 % of cases, and thus changing its management in 78 % of cases, deriving a survival rate of 40 % versus an expected survival rate of 3.85 % [17,18]. Though considering the effective outcome (surviving to discharge) that could be estimated of 36.5 %, there is a mortality reduction of 1.7/15 patients.…”

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confidence: 99%

Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department

et al. 2015

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The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as ''the stethoscope of the 21st century''. However, at present, bedside ultrasonography lacks economic analysis. We performed a CostBenefit Analysis ''ex ante'', with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets), other than evident medical benefits.

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Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: A prospective trial

Cited by 396 publications

References 36 publications

Early identification of aortic dissection with pre-hospital ultrasound: a case report.

Early identification of aortic dissection with pre-hospital ultrasound: a case report.

Use of Point-of-Care Ultrasonography in Simulation-Based Advanced Cardiac Life Support Scenarios

Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department

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