Use of ultrasound by emergency medical services: a review

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Abstract

Prehospital ultrasound has been deployed in certain areas of the USA and Europe. Physicians, emergency medical technicians, and flight nurses have utilized a variety of medical and trauma ultrasound assessments to impact patient care in the field. The goal of this review is to summarize the literature on emergency medical services (EMS) use of ultrasound to more clearly define the potential utility of this technology for prehospital providers.

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Most cited references 43

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Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial.

Peter Lopez, Adrian W Briggs, Lawrence Melniker … (2006)

Annually, 38 million people are evaluated for trauma, the leading cause of death in persons younger than 45 years. The primary objective is to assess whether using a protocol inclusive of point-of-care, limited ultrasonography (PLUS), compared to usual care (control), among patients presenting to the emergency department (ED) with suspected torso trauma decreased time to operative care. The study was a randomized controlled clinical trial conducted during a 6-month period at 2 Level I trauma centers. The intervention was PLUS conducted by verified clinician sonographers. The primary outcome measure was time from ED arrival to transfer to operative care; secondary outcomes included computed tomography (CT) use, length of stay, complications, and charges. Regression models controlled for confounders and analyzed physician-to-physician variability. All analyses were conducted on an intention-to-treat basis. Results are presented as mean, first-quartile, median, and third-quartile, with multiplicative change and 95% confidence intervals (CIs), or percentage with odds ratio and 95% CIs. Four hundred forty-four patients with suspected torso trauma were eligible; 136 patients lacked consent, and attending physicians refused enrollment of 46 patients. Two hundred sixty-two patients were enrolled: 135 PLUS patients and 127 controls. There were no important differences between groups. Time to operative care was 64% (48, 76) less for PLUS compared to control patients. PLUS patients underwent fewer CTs (odds ratio 0.16) (0.07, 0.32), spent 27% (1, 46) fewer days in hospital, and had fewer complications (odds ratio 0.16) (0.07, 0.32), and charges were 35% (19, 48) less compared to control. A PLUS-inclusive protocol significantly decreased time to operative care in patients with suspected torso trauma, with improved resource use and lower charges.

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Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm.

T F Seeger, Raoul Breitkreutz, Felix Walcher (2007)

Emergency ultrasound is suggested to be an important tool in critical care medicine. Time-dependent scenarios occur during preresuscitation care, during cardiopulmonary resuscitation, and in postresuscitation care. Suspected myocardial insufficiency due to acute global, left, or right heart failure, pericardial tamponade, and hypovolemia should be identified. These diagnoses cannot be made with standard physical examination or the electrocardiogram. Furthermore, the differential diagnosis of pulseless electrical activity is best elucidated with echocardiography. Therefore, we developed an algorithm of focused echocardiographic evaluation in resuscitation management, a structured process of an advanced life support-conformed transthoracic echocardiography protocol to be applied to point-of-care diagnosis. The new 2005 American Heart Association/European Resuscitation Council/International Liaison Committee on Resuscitation guidelines recommended high-quality cardiopulmonary resuscitation with minimal interruptions to reduce the no-flow intervals. However, they also recommended identification and treatment of reversible causes or complicating factors. Therefore, clinicians must be trained to use echocardiography within the brief interruptions of advanced life support, taking into account practical and theoretical considerations. Focused echocardiographic evaluation in resuscitation management was evaluated by emergency physicians with respect to incorporation into the cardiopulmonary resuscitation process, performance, and physicians' ability to recognize characteristic pathology. The aim of the focused echocardiographic evaluation in resuscitation management examination is to improve the outcomes of cardiopulmonary resuscitation.

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Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram.

M Blaivas, Naomi J. Fox (2001)

Patients presenting in cardiac arrest frequently have poor outcomes despite heroic resuscitative measures in the field. Many emergency medical systems have protocols in place to stop resuscitative measures in the field; however, further predictors need to be developed for cardiac arrest patients brought to the emergency department (ED). To examine the predictive value of cardiac standstill visualized on bedside ED echocardiograms during the initial presentations of patients receiving cardiopulmonary resuscitation (CPR). The study took place in a large urban community hospital with an emergency medicine residency program and a high volume of cardiac arrest patients. As part of routine care, all patients arriving with CPR in progress were subject to immediate and brief subxiphoid or parasternal cardiac ultrasound examination. This was followed by brief repeat ultrasound examination during the resuscitation when pulses were checked. A 2.5-MHz phased-array probe was used for imaging. Investigators filled out standardized data sheets. Examinations were taped for review. Statistical analysis included descriptive statistics, positive and negative predictive values, and likelihood ratios. One hundred sixty-nine patients were enrolled in the study. One hundred thirty-six patients had cardiac standstill on the initial echocardiogram. Of these, 71 patients had an identifiable rhythm on monitor. No patient with sonographically identified cardiac standstill survived to leave the ED regardless of his or her initial electrical rhythm. Cardiac standstill on echocardiogram resulted in a positive predictive value of 100% for death in the ED, with a negative predictive value of 58%. Patients presenting with cardiac standstill on bedside echocardiogram do not survive to leave the ED regardless of their electrical rhythms. This finding was uniform regardless of downtime. Although larger studies are needed, this may be an additional marker for cessation of resuscitative efforts.

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Author and article information

Contributors

: +1-212-2416794 , Bret.Nelson@mountsinai.org,

Bio :

Bret P. Nelson is the Director of Emergency Ultrasound in the Department of Emergency Medicine at the Mount Sinai School of Medicine in New York City. He has lectured on ultrasound throughout the USA and Europe. He recently coauthored the Manual of Emergency and Critical Care Ultrasound (Cambridge University Press). He has earned teaching awards from Harvard Medical School and Mount Sinai School of Medicine. His research includes ultrasound education, trauma ultrasound, and prehospital ultrasound.

Bio :

Kevin Chason is the Director of Emergency Management and Prehospital Care at The Mount Sinai Hospital. He is responsible for planning, mitigation, response, and recovery activities for disasters. He is also the Medical Director for Mount Sinai Emergency Medical Services (EMS) which is a voluntary hospital EMS participating with the Fire Department of New York (FDNY) to provide prehospital care to New York City. He has lectured on emergency preparedness internationally and is faculty for The Center for Domestic Preparedness training health care leadership in hospital emergency response. He is also a medical officer for US Health and Human Services Disaster Medical Response Teams and has responded providing medical services to the areas affected by Hurricanes Katrina and Rita.

Journal

Journal ID (nlm-ta): Int J Emerg Med

Title: International Journal of Emergency Medicine

Publisher: Springer-Verlag (London )

ISSN (Print): 1865-1372

ISSN (Electronic): 1865-1380

Publication date (Electronic): 11 November 2008

Publication date PMC-release: 11 November 2008

Publication date Collection: December 2008

Volume: 1

Issue: 4

Pages: 253-259

Affiliations

Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1149, New York, NY 10029 USA

Article

Publisher ID: 75

DOI: 10.1007/s12245-008-0075-6

PMC ID: 2657261

PubMed ID: 19384639

SO-VID: fa185c34-85de-44c6-8d36-da6c37215e1d

History

Date received : 10 April 2008

Date accepted : 8 October 2008

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ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: ultrasound,emergency medical services,disaster

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ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: ultrasound, emergency medical services, disaster

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Use of ultrasound by emergency medical services: a review

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Preventive and Emergency Medicine Insights

Most cited references 43

Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial.

Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm.

Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram.

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Cited by 25

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