Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHoC investigators

Resuscitation ◽  
2019 ◽  
Vol 139 ◽  
pp. 159-166 ◽  
Author(s):  
Elizabeth Lalande ◽  
Talia Burwash-Brennan ◽  
Katharine Burns ◽  
Paul Atkinson ◽  
Michael Lambert ◽  
...  
CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S22-S23
Author(s):  
E. Lalande ◽  
T. Burwash-Brennan ◽  
K. Burns ◽  
P. Atkinson ◽  
M. Lambert ◽  
...  

Introduction: Point-of-Care Ultrasound (PoCUS) is being increasingly utilized during cardiac arrests for prognosis. Following the publication of recent studies, the goal of this study was to systematically review and analyze the literature to evaluate the accuracy of PoCUS in predicting return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) in adult patients with non-traumatic, non- shockable out- of-hospital or emergency department cardiac arrest. Methods: A systematic review and meta-analysis was completed. A search of Medline, EMBASE, Cochrane, CINAHL, ClinicalTrials.gov and the World Health Organization Registry was completed from 1974 until August 24th 2018. Adult randomized controlled trials and observational studies were included. The QUADAS-2 tool was applied by two independent reviewers. Data analysis was completed according to PRISMA guidelines and with a random effects model for the meta-analysis. Heterogeneity was assessed using I-squared statistics. Results: Ten studies (1,485 participants) were included. Cardiac activity on PoCUS had a pooled sensitivity of 59.9% (95% confidence interval 36.5%-79.4%) and specificity of 91.5% (80.8%-96.5%) for ROSC; 74.7% (58.3%-86.2%) and 80.5% (71.7%-87.4%) for SHA; and 69.4% (45.5%-86.0%) and 74.6% (59.8%-85.3%) for SHD. The sensitivity of cardiac activity on PoCUS for predicting ROSC was 24.7%(6.8%-59.4%) in the asystole subgroup compared with 77% (59.4%-88.5%) within the PEA subgroup. Cardiac activity on PoCUS, compared to an absence had an odd ratio of 15.9 (5.9-42.5) for ROSC, 9.8 (4.9-19.4) for SHA and 5.7 (2.1-15.6) for SHD. Positive likelihood ratio (LR) was 6.65 (3.16-14.0) and negative LR was 0.27 (0.12-0.61) for ROSC. Conclusion: Cardiac activity on PoCUS was associated with improved odds for ROSC, SHA, and SHD among adults with non-traumatic asystole and PEA. We report lower sensitivity and higher negative likelihood ratio, but with greater heterogeneity compared to previous systematic reviews. PoCUS may provide valuable information in the management of non-traumatic PEA or asystole, but should not be viewed as the sole predictor in determining outcomes in these patients.


2018 ◽  
Vol 25 (6) ◽  
pp. 684-698 ◽  
Author(s):  
Charles Wong ◽  
Braden Teitge ◽  
Marshall Ross ◽  
Paul Young ◽  
Helen Lee Robertson ◽  
...  

2019 ◽  
Vol 37 (9) ◽  
pp. 1760-1769 ◽  
Author(s):  
Po-Yang Tsou ◽  
Yu-Hsun Wang ◽  
Yu-Kun Ma ◽  
Julia K. Deanehan ◽  
Jason Gillon ◽  
...  

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ilan Kedan ◽  
William Ciozda ◽  
Joseph A. Palatinus ◽  
Helen N. Palatinus ◽  
Asher Kimchi

Resuscitation ◽  
2017 ◽  
Vol 114 ◽  
pp. 92-99 ◽  
Author(s):  
Po-Yang Tsou ◽  
Jeantte Kurbedin ◽  
Yueh-Sheng Chen ◽  
Eric H. Chou ◽  
Meng-tse Gabriel Lee ◽  
...  

2021 ◽  
Author(s):  
Leon Byker ◽  
Brian Buchanan ◽  
Jocelyn Slemko ◽  
Irene Ma ◽  
Jason Weacher ◽  
...  

Abstract BackgroundBeginning with the guidance of central line insertion, point-of-care ultrasound (POCUS) has evolved into a more inclusive skill set to aid in the examination and management of the acutely ill patient. Published evidence, including original literature and consensus recommendations support an array of applications in the multi-disciplinary arena of acute care medicine. In parallel, we have seen multiple professional societies’ call for more POCUS training in residency. While POCUS has been received with enthusiasm in acute care medicine, there are a number of challenges to ensuring trainees can competently perform POCUS in the acute care environment. There is inconsistent evidence to support optimum practices in curriculum design, implementation, assessment, and evaluation. To help explore this gap, we are conducting a systematic review and meta-analysis of current evidence regarding POCUS curricula.MethodsWe will search electronic databases: MEDLINE, Embase, Cochrane Library, CINAHL, Ovid ERIC, Science Citation Index, and Conference Proceedings Citation Index. Further, we will search the ClinicalTrials.gov register, hand search key proceedings and check references from relevant systematic reviews. Title, abstract and full text screening for inclusion of eligible papers will be performed in duplicate, in accordance with the PRISMA statement. Included publications will be evaluated for internal validity using the Medical Education Research Study Quality Instrument (MERSQI) scale for educational studies. Data abstraction will be conducted using standardized forms with focus on learner population, number of participants, setting, POCUS application, methods of instruction, duration of intervention, methods of assessment, and program evaluation. Further to this, emphasis will be placed on validity arguments of assessment tools using Kane’s framework. Primary analysis will be qualitative in nature. When possible, homogenous studies will be pooled for quantitative meta-analysis.DiscussionOur systematic review will summarize the current evidence base for POCUS curriculum implementation, evaluation and assessment validity for acute care applications. We anticipate that our review will fill a critical knowledge gap, providing a sound platform for future evidence-based curriculum development.Systematic Review RegistrationOur systematic review was registered with the International prospective register of systematic reviews (PROSPERO) on September 19, 2018 with registration number: CRD42018105973.


Sign in / Sign up

Export Citation Format

Share Document