US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: Validation and potential impact

Lien, Wan‐Ching; Hsu, Shun-Chin; Chong, Kah-Meng; Sim, Shyh-Shyong; Wu, Meng‐Che; Chang, Wei‐Tien; Fang, Cheng-Chung; Huei‐Ming, Matthew; Chen, Shyr‐Chyr; Chen, Wen‐Jone

doi:10.1016/j.resuscitation.2018.01.051

Cited by 50 publications

(40 citation statements)

References 35 publications

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“…By contrast, previous studies showed that US-related pause duration would be lengthened to 17-21s [15,[18][19][20]. However, this could be shortened by the implementation of a structured US protocol and the presence of US-trained faculties [7,20,21]. Whether US impacts negatively on CCF remains unclear.…”

Section: Introductionmentioning

confidence: 86%

“…Ultrasonography (US) is a real-time, non-invasive, readily accessible diagnostic tool, frequently deployed in the emergency departments (EDs). It has been increasingly used in certain critical scenarios such as shock, dyspnea and cardiac arrest [1][2][3][4][5][6][7] to search for possible reversible causes and guide clinical management. Current guidelines for advanced life support (ALS) suggest that US can be an integral part of resuscitative medicine [8].…”

Section: Introductionmentioning

confidence: 99%

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The impact of ultrasonography on quality of cardiopulmonary resuscitation: a retrospective observational study

Lien

Chong

Chang

et al. 2019

Preprint

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Background: This study aims to evaluate the effect of ultrasonography (US) on quality of cardiopulmonary resuscitation (CPR), and US-related pause duration of pulse-checks.Methods: This retrospective observational study was conducted at the emergency department of National Taiwan University Hospital between April 2017 and May 2018. Video recordings for adult patients with non-traumatic cardiac arrest in designated resuscitation rooms were collected. The primary outcome was chest compression fraction (CCF) in the CPR with US group. The secondary outcome was pause duration of pulse checks with introduction of US or not. US-related pulse-checks were stratified into US during hands-off periods only (hands-off US), and US performing from hands-off to hands-on periods (continuous US). Results: A total of 153 patients were enrolled. Continuous US was performed in 116 patients. CCF was similar (92%) between the CPR with and without US groups. In the CPR with US group, pause duration was significantly longer in US-related pulse-checks than that without US (9.3±8.0 v.s. 7.3±4.7s, p<0.0001). Notably, longer pause was noted in the hands-off US, as comparing with that in the continuous US (18.3±16.4 v.s. 7.7±3.5s, p<0.0001). Conclusions: The introduction of US during CPR did not impact on CCF. Individual pause would not be lengthened if continuous US was performed while allowing chest compressions to be resumed. In addition, structured training, adequate facilities and manpower, and a timer reminding resumption of chest compressions would help sophisticated integration of US into CPR process.

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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

The impact of ultrasonography on quality of cardiopulmonary resuscitation: a retrospective observational study

Lien

Chong

Chang

et al. 2019

Preprint

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“…This was further validated in more recent study, the US-CAB protocol where cardiac activity identified in 47 cases (26.6%) out of a total of 177 arrest patients being studied was associated with higher rates of ROSC (95.7% vs. 21.5%, p < 0.0001) and survival to hospital discharge (25.5% vs. 10.0%, p < 0.01). Furthermore, detection of cardiac activity after 10 min of CPR exhibited 100% sensitivity, specificity, positive and negative predictive value for ROSC [18].…”

Section: Identification Of Cardiac Standstillmentioning

confidence: 94%

“…However, several studies have demonstrated accurate cardiac ultrasound skills by emergency medicine physicians as well as emergency medicine residents with good correlation to cardiologists' skills [15][16][17]. One study found that the implementation of a standardized 6-month course for emergency healthcare providers allowed them to utilize bedside ultrasonography to efficiently obtain useful prognostic indicators of survival and ROSC while still maintaining between-compression delays of less than 10 s [18].…”

Section: Level Of Competencymentioning

confidence: 99%

Bedside ultrasound in cardiac standstill: a clinical review

et al. 2019

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Patients with cardiac arrest present as a relatively frequent occurrence in the Emergency Department. Despite the advances in our understanding of the pathophysiology of cardiac arrest, managing the condition remains a stressful endeavor and currently implemented interventions, while beneficial, are still associated with a disappointingly low survivability. The majority of modern Advanced Life Support algorithms employ a standardized approach to best resuscitate the 'crashed' patient. However, management during resuscitation often encourages a 'one-size-fitsall' policy for most patients, with lesser attention drawn towards causality of the disease and factors that could alter resuscitative care. Life support providers are also often challenged by the limited bedside predictors of survival to guide the course and duration of resuscitation. Over the recent decades, point-of-care ultrasonography (PoCUS) has been gradually proving itself as a useful adjunct that could potentially bridge the gap in the recognition and evaluation of precipitants and end-points in resuscitation, thereby facilitating an improved approach to resuscitation of the arrested patient. Point-of-care ultrasound applications in the critical care field have tremendously evolved over the past four decades. Today, bedside ultrasound is a fundamental tool that is quick, safe, inexpensive and reproducible. Not only can it provide the physician with critical information on reversible causes of arrest, but it can also be used to predict survival. Of note is its utility in predicting worse survival outcomes in patients with cardiac standstill, i.e., no cardiac activity witnessed with ultrasound. Unfortunately, despite the increasing evidence surrounding ultrasound use in arrest, bedside ultrasound is still largely underutilized during the resuscitation process. This article reviews the current literature on cardiac standstill and the application of bedside ultrasound in cardiac arrests.

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“…The use of PoCUS rst can answer important clinical questions accurately without time delay, and avoid side effects of unnecessary, advanced imaging [8]. PoCUS has shown its value in rapidly diagnose critical conditions such as shock, dyspnea, and cardiac arrest [9][10][11][12]. Evidence regarding the application of PoCUS in non-critical patients with abdominal distention was limited in the literature [13,14].…”

Section: Introductionmentioning

confidence: 99%

A Simple Fask Protocol as an Effective Screening Tool for Patients With Abdominal Distention

Lien

Chen

Wang

et al. 2020

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Background: The retrospective study aimed to investigate the effect of point-of-care ultrasound (PoCUS) by a designated protocol for patients with abdominal distention.Methods: Non-traumatic adult patients with abdominal distention were included at the emergency department (ED) of the National Taiwan University Hospital between July 2015 and July 2017. A sonographic scanning protocol (FASK, the focused assessment with sonography in trauma plus the renal US) was included in the post-graduate year and residency US training. The primary outcome included the diagnostic accuracy of the FASK protocol. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the protocol were calculated that discharge/admission diagnosis was as the standard. The secondary outcomes included ED LOS and the rate of ED discharge using the FASK protocol.Results: A total of 512 patients were included. The accuracy of the FASK protocol was 99.0% (507/512), whatever the level of the performer. The sensitivity, specificity, PPV, and NPV were 99.4% (95% CIs, 98.2-99.9%), 100% (95% CIs, 100%), 99.6% (95% CIs, 98.6-100%), and 99% (95% CIs, 97.7-99.7%), respectively. 397 patients (78%) were discharged with the median LOS of 126 minutes (IQR, 84-236 minutes) after receiving PoCUS and proper management. PoCUS was performed approximately 3 hours earlier than CT (median, 179 minutes; IQR, 90-468 minutes; p<0.0001).Conclusions: A simple FASK protocol could be an effective screening tool for non-critical patients with abdominal distention. Being an adjunct of physical examination and management, PoCUS exhibited characteristics of efficacy, timeliness, and safety.Trial registration: NCT04149041 at ClinicalTrials.gov.

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US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: Validation and potential impact

Cited by 50 publications

References 35 publications

The impact of ultrasonography on quality of cardiopulmonary resuscitation: a retrospective observational study

The impact of ultrasonography on quality of cardiopulmonary resuscitation: a retrospective observational study

Bedside ultrasound in cardiac standstill: a clinical review

A Simple Fask Protocol as an Effective Screening Tool for Patients With Abdominal Distention

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