Written by Megan Hilbert
Spoon Feed
This expert panel from Canada has compiled a list of what they deem to be the most influential POCUS papers with regard to cardiac arrest as well as evaluation of shock. Whether you want to further educate yourself or guide your residents to learn more on the subject, this primer is a great place to start.
Picking the needles out of the haystack
14 POCUS experts participated in a modified Delphi process in order to compile this primer. While there are some limitations to their methods – including lack of members dual boarded in critical care as well as heterogeneity of the methods of the included papers – they have successfully reduced a mountain of evidence and papers into a much more approachable mole hill. Not only do they select the papers, they also include a quick overview of the most salient points. I will defer the overview to them as I fear anything I would do here would be a gross over-simplification of these complex topics. Please note, they did not include any discussion regarding how POCUS tends to prolong pulse checks, and they recognize that as an additional limitation.
Seriously, go read the primer. It is only 7 pages long, and you will walk away with a plethora of high-yield material.
[If you prefer to not read the primer please see the list of the selected papers below.]
How will this change my practice?
I always appreciate a simplified approach to a complex topic – and wading through literature is no different. I plan to refer the residents I work with to this primer in order to further their education and to support on-shift learning.
[Good news: this is an entire series and therefore there are primers for other POCUS applications as well!]
Source
POCUS literature primer: key papers on POCUS in cardiac arrest and shock. CJEM. 2023 Nov 23. doi: 10.1007/s43678-023-00611-1. Epub ahead of print.
Another Spoonful of POCUS Papers
Cardiac arrest
- Gaspari R et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation. 2016;109:33-9.
- Blaivas M, Fox JC. Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram. Acad Emerg Med. 2001;8(6):616-21.
- Lalande E et al. Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHoC investigators. Resuscitation. 2019;139:159-66.
- Gaspari R et al. A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study. Resuscitation. 2017; 210:103-7.
- Atkinson P et al. International Federation for Emergency Medicine consensus statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point-of-care ultrasound for undifferentiated hypotension and during cardiac arrest. CJEM. 2017;19(6):459-70.
Shock
- Jones AE et al. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004;32(8):1703-8.
- Atkinson PR et al. Does point-of-care ultrasonography improve clinical outcomes in emergency department patients with undifferentiated hypotension? An international randomized controlled trial form the SHoC-ED investigators. Ann Emerg Med. 2018;72(4):478-89.
- Shokoohi H et al. Bedside ultrasound reduces diagnostic uncertainty and guides resuscitation in patients with undifferentiated hypotension. Crit Care Med. 2015;43(12):2562-9.
- Stickles SP et al. The diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology: A systematic review and meta-analysis. CJEM. 2019;21(3):406-17.
- Perera P et al. The RUSH exam: Rapid Ultrasound in Shock in the evaluation of the critically ill. Emerg Med Clin North Am. 2010;28(1):29-56, vii.
