POCUS for Shock – Don’t Be SHoC-ED
July 4, 2018
Happy Independence Day, US Friends!
A word about politics.
I think the answer is empathy.
Enough said.
Written by Clay Smith
Spoon Feed
Point-of-care ultrasound (POCUS) in addition to usual care did not improve 30-day mortality in ED patients with undifferentiated hypotension, SBP <100mmHg.
Why does this matter?
POCUS can come in handy to rapidly diagnose certain potentially lethal conditions, such as cardiac tamponade. Does it impact mortality in patients with undifferentiated hypotension?
Don’t be SHoC-ED
This was a multi-center RCT of 273 ED patients with undifferentiated hypotension, defined as SBP <100 or shock index >1. Half received POCUS plus usual care and half usual care with no POCUS. They found no mortality benefit (POCUS 23.5% mortality; no POCUS 23.8%) or other benefit for secondary outcomes: length of stay, rates of CT scanning, inotrope use, or fluid administration. One wonders if a more strict definition or narrower inclusion criteria might have been of benefit. Hypotension is usually defined as <90 in adults, which may have led to inclusion of less sick people and a dilution of any mortality benefit for ultrasound-guided care. They state, “Our findings may reflect that the use of point-of-care ultrasonography should be targeted to answer specific clinical questions that are relevant to each particular patient, rather than following a one-size-fits-all protocol.”
Source
Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators. Ann Emerg Med. 2018 Jun 2. pii: S0196-0644(18)30325-1. doi: 10.1016/j.annemergmed.2018.04.002. [Epub ahead of print]
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Another Spoonful
For a detailed review of SHoC-ED, The Bottom Line is best, also with a list of free online resources about using ultrasound in shock patients.
Reviewed by Thomas Davis