Carotid Artery Flow Time Measured by Point-of-Care Ultrasound Correlates with Volume Changes in Pediatric Hemodialysis Patients

Introduction: Emergency physicians can use B-mode Point-of-Care Ultrasound (POCUS) to identify a patient’s carotid vasculature including the common carotid artery (CCA), and carotid bulb (CB) as well as carotid bifurcation into the internal carotid artery (ICA) and external carotid artery (ECA). Radiology performed carotid ultrasound (RPCU) is performed using both B-mode and spectral Doppler ultrasound, a combination termed “duplex” ultrasound where first arteries are evaluated for stenosis using B-mode ultrasound, which is followed by flow measurements using Doppler. Performing flow measurements using Doppler may add a significant amount of time to the ultrasound, which makes it impractical for an emergency physician in a busy emergency department. Some institutional practices include arranging for outpatient RPCU to assess patients with Transient Ischemic Attack (TIA) and have them follow up in an outpatient TIA clinic. This study explored whether B-mode POCUS without Doppler may help identify Stroke or TIA patients in the emergency department with significant carotid stenosis (CS) by measuring the CCA, CB, and ICA lumen. Methods: Adult patients with an emergency physician diagnosis of stroke or TIA who were sent for RPCU were included in this study. An emergency medicine resident in their POCUS fellowship training performed a B-mode POCUS of the patient’s right and left CCA, CB and ICA with the patient sitting 90 degrees. Three measurements of each of the 3 sections were obtained and the mean calculated. This was then compared to the results from the RPCU as CS >50% or CS <50%. Results: 38 patients were included in the study between February and June 2013. We observed a correlation between absolute differences in comparing the right side of the carotid vasculature to the left side of the carotid vasculature with CS >50%. Also, in one case, the absolute lumen diameter with B-mode POCUS without Doppler predicted near complete CS which was confirmed on the RPCU. Conclusion: B-mode POCUS without Doppler may be useful in identifying patients with CS above and below 50% and may help identify patients who need expedited referrals for CS. However, further research is required before this method can be recommended.

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Can Emergency Physicians Perform Carotid Artery Point-of-Care Ultrasound to Detect Stenosis in Patients with TIA and Stroke? A Pilot Study

Western Journal of Emergency Medicine ◽

10.5811/westjem.2020.2.45137 ◽

2020 ◽

Vol 21 (3) ◽

Author(s):

Robert Suttie ◽

Michael Woo ◽

Lily Park ◽

Marie-Joe Nemnom ◽

Grant Stotts ◽

...

Keyword(s):

Pilot Study ◽

Carotid Artery ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Emergency Physicians

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PC062. Point-of-Care Ultrasound to Evaluate for Asymptomatic Carotid Artery Stenosis in Patients With Known Vascular Disease—A Quality Improvement Initiative

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.04.324 ◽

2019 ◽

Vol 69 (6) ◽

pp. e221-e222

Author(s):

Mary Kathryn Huddleston ◽

Jenny H. Holcombe ◽

Michael S. Greer

Keyword(s):

Quality Improvement ◽

Carotid Artery ◽

Vascular Disease ◽

Carotid Artery Stenosis ◽

Point Of Care ◽

Artery Stenosis ◽

Quality Improvement Initiative ◽

Point Of Care Ultrasound ◽

Asymptomatic Carotid ◽

Asymptomatic Carotid Artery Stenosis

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Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

Journal of Ultrasound ◽

10.1007/s40477-014-0139-9 ◽

2014 ◽

Vol 18 (2) ◽

pp. 127-133 ◽

Cited By ~ 12

Author(s):

Marika Gassner ◽

Keith Killu ◽

Zachary Bauman ◽

Victor Coba ◽

Kelly Rosso ◽

...

Keyword(s):

Cardiac Output ◽

Carotid Artery ◽

Common Carotid Artery ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Cardiac Output Measurements

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Ultrasonography of a Helical Left Common Carotid Artery

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.2.46272 ◽

2020 ◽

Vol 4 (2) ◽

pp. 230-231

Author(s):

Bethany Busack ◽

Vy Tran ◽

Christopher Busack ◽

Christine Butts

Keyword(s):

Carotid Artery ◽

Internal Jugular Vein ◽

Common Carotid Artery ◽

Jugular Vein ◽

Point Of Care ◽

Standard Of Care ◽

Central Venous Line ◽

Point Of Care Ultrasound ◽

Central Venous ◽

Central Lines

Case Presentation: An 83-year-old woman was admitted to the intensive care unit for septic shock at which point an internal jugular central venous line was placed. The patient’s common carotid artery was visualized in an atypical location, lateral to the internal jugular vein. Further inspection revealed the common carotid artery travelling in a rotational trajectory around the internal jugular vein. Discussion: For at least two decades, point-of-care ultrasound has become the standard of care for placing central venous lines. This surprising anatomical orientation is rare and cautions physicians to fully explore a patient’s anatomy prior to placing central lines.

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The effect of norepinephrine on common carotid artery blood flow in septic shock patients

Scientific Reports ◽

10.1038/s41598-021-96082-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Seok Goo Kim ◽

Ik Joon Jo ◽

Soo Yeon Kang ◽

Jonghoon Yoo ◽

Guntak Lee ◽

...

Keyword(s):

Septic Shock ◽

Blood Flow ◽

Carotid Artery ◽

Common Carotid Artery ◽

Point Of Care ◽

Peak Systolic Velocity ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Point Of Care Ultrasound ◽

Left Ventricular Outflow

AbstractThis study was designed to evaluate the hemodynamic effect of norepinephrine (NE) on the peak systolic velocity (PSV), diameter, and blood flow of the common carotid artery (CCA) using the point-of-care ultrasound (POCUS) in patients with septic shock. The study involved patients above 18 years old with septic shock. Arterial monitoring, carotid ultrasonography, and transthoracic echocardiography were performed before NE administration (T0). When the mean arterial pressure exceeded 65 mmHg after NE administration (T1), the measurement was repeated. Twenty-four patients (median age 67 [interquartile range: 54–77] years; 42% female) with septic shock were examined in this study. Before (T0) and after (T1) NE administration, the PSV (mean, standard deviation [SD]) changed from 85.3 (21.1) cm/s to 83.5 (23.5) cm/s (p = 0.417); this change was not significant. However, the diameter and blood flow of the CCA increased significantly from 0.6 (0.09) cm and 0.75 (0.27) L/min to 0.66 (0.09) cm and 0.85 (0.27) L/min, respectively (p < 0.001). The diameter of the left ventricular outflow tract (LVOT) remained unchanged, but the velocity time integral of the LVOT increased significantly from 21.7 (4.39) cm to 23.6 (5.14) cm. There was no significant correlation between changes in blood flow of the CCA and changes in cardiac output (coefficient −0.365, p = 0.079). In conclusion, NE increased the diameter and blood flow of the CCA significantly, without changing the PSV in patients with septic shock.

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