HEFTEMCAST

POCUS TRIAL

USS IN CARDIAC ARREST

Meta analysis from Blyth 2012 showed;

Cardiaic motility as a predictor of ROSC

Positive likelihood ratio 4.26 (95% CI = 2.63 to 6.92),

Negative likelihood ratio was 0.18

THE PAPER

Laursen, Christian B., et al. "Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind,

randomised controlled trial." The Lancet Respiratory Medicine (2014).

The POCUS trial

PATIENTSProspective RCT

Single centre hospital, Denmark

Inclusion criteria

RR > 20 bpm, SpO2 < 95%, commenced on O2 therapy

Description of current/previous dyspnoea/cough/chest pain were screened for eligibility

Exclusion criteria

Mental disability, < 18 years of age, point of care USS not performed with 1 hr after the primary assessment

INTERVENTION

Control group had a standard diagnostic work up

POC group had the standard work up + USS of heart and lungs and deep veins in the legs

The results of the USS were communicated to the clinician providing clinical care for the patient to inform their diagnostics and management plan

Compared diagnosis at 4hrs matched with the discharge diagnosis

COMPARISON

OUTCOME

Correct diagnosis 88% (POC) vs 64% (control) p-value <0.0001

REFERNECES• Vidakovik R, Feringa HH, Kuiper RJ, Karagiannis SE, Schouten O, Dunkelgrun M, Hoeks

SE, Bom N, Bax JJ, Neskovic AN, Poldermans D. Comparison with computed tomography of two ultrasound devices for diagnosis of abdominal aortic aneurysm. Am J Cardiol 2007 Dec15;100 (12):1786 91.

• Dent B, Kendall RJ, Boyle AA, Atkinson PR. Emergency ultrasound of the abdominal aorta by UK emergency physicians: a prospective cohort study. Emerg Med J. 2007 Aug;24(8):547-9.

• Taval VS, Graf CD, Gibbs MA. Prospective study of accuracy and outcome of emergency ultrasound for aortic aneurysm over two years. Acad Emerg Med. 2003 Aug;10(8):867-71

• Blyth, L., Atkinson, P., Gadd, K. and Lang, E. (2012), Bedside Focused Echocardiography as Predictor of Survival in Cardiac Arrest Patients: A Systematic Review. Academic Emergency Medicine, 19: 1119–1126.