Paul Atkinson1, Justin Bowra2, James Milne3, David Lewis1, Mike Lambert4, Bob Jarman5, Vicki E Noble6, Hein Lamprecht7, Tim Harris5, Jim Connolly8. 1. *Dalhousie University,Saint John, NB. 2. ‡Sydney Adventist Hospital,Wahroonga,Australia. 3. ¶Fraser Health Authority,Surrey, BC. 4. **Advocate Christ Medical Centre,Oak Lawn, IL. 5. †††Barts Health NHS Trust,London,UK. 6. §§University Hospitals Cleveland Medical Center,Cleveland, OH. 7. ***Stellenbosch University,Stellenbosch,South Africa. 8. ††Royal Victoria Infirmary,Newcastle upon Tyne,UK.
Abstract
Introduction The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest. METHODS: The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol. RESULTS: Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the "4 F" approach: fluid, form, function, filling. CONCLUSION: An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
Introduction The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest. METHODS: The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol. RESULTS: Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the "4 F" approach: fluid, form, function, filling. CONCLUSION: An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
Entities:
Keywords:
hypotension; life support; shock; ultrasound
Authors: Jaydev K Dave; Maureen E Mc Donald; Praveen Mehrotra; Andrew R Kohut; John R Eisenbrey; Flemming Forsberg Journal: Ultrasonics Date: 2017-11-23 Impact factor: 2.890
Authors: Paul R Atkinson; Andrew W Keyes; Kathleen O'Donnell; Nicole Beckett; Ankona Banerjee; Jacqueline Fraser; David Lewis Journal: Cureus Date: 2018-11-23