[Show abstract][Hide abstract] ABSTRACT: Focused ultrasound is increasingly used in the emergency setting, with an ALS-compliant focused echocardiography algorithm proposed as an adjunct in peri-resuscitation care (FEEL). The purpose of this study was to evaluate the feasibility of FEEL in pre-hospital resuscitation, the incidence of potentially treatable conditions detected, and the influence on patient management.
A prospective observational study in a pre-hospital emergency setting in patients actively undergoing cardio-pulmonary resuscitation or in a shock state. The FEEL protocol was applied by trained emergency doctors, following which a standardised report sheet was completed, including echo findings and any echo-directed change in management. These reports were then analysed independently.
A total of 230 patients were included, with 204 undergoing a FEEL examination during ongoing cardiac arrest (100) and in a shock state (104). Images of diagnostic quality were obtained in 96%. In 35% of those with an ECG diagnosis of asystole, and 58% of those with PEA, coordinated cardiac motion was detected, and associated with increased survival. Echocardiographic findings altered management in 78% of cases.
Application of ALS-compliant echocardiography in pre-hospital care is feasible, and alters diagnosis and management in a significant number of patients. Further research into its effect on patient outcomes is warranted.
[Show abstract][Hide abstract] ABSTRACT: Successful resuscitation requires potentially reversible causes to be diagnosed and reversed, and many of these can readily be diagnosed using echocardiography. Although members of the resuscitation team routinely use adjuncts to their clinical examination in order to differentiate these causes, the use of echocardiography is not yet considered standard. The purpose of this review is to discuss the potential for echocardiography to aid diagnosis and treatment during resuscitation, together with some of the perceived challenges that currently limit its widespread use.
Many studies have demonstrated the value of echocardiography in the assessment of critically ill patients in the intensive care unit and emergency room settings, including more recently the use of focused echocardiography. This can be performed within the time frame allowed during the pulse check of the advanced life support (ALS) algorithm. ALS-compliant focused echocardiography can be taught to nonexpert practitioners such that high-quality cardiopulmonary resuscitation is not compromised while diagnosing/excluding some of the potential causes of cardiac arrest.
Persistent and worsening haemodynamic instability are regarded as clear indications for echocardiography. The focused application of this well established technique within the ALS algorithm provides the resuscitation team with a potentially powerful diagnostic tool that can be used to diagnose/exclude some of the potentially treatable causes of cardiac arrest as well as to guide therapeutic interventions. The impact of routine periresuscitation echocardiography on patient outcomes both for in-hospital and prehospital care remains an exciting avenue for future research.
Current opinion in critical care 06/2010; 16(3):211-5. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: a b s t r a c t Aims: Echocardiography performed in an ALS-compliant manner provides a tool whereby some of the potentially reversible causes of cardiac arrest can be diagnosed in real time by minimally trained practi-tioners. One of the major concerns this raises is how to deliver effective training to the required standard. The objective of this study was to determine the effectiveness of number of different educational meth-ods used teach echocardiography to novices. This involved assessment of cognitive, psychomotor skills and affective aspects in five key areas. Methods: The study population was a convenience sample from participants attending standardised struc-tured one-day training courses in peri-resuscitation echocardiography (n = 204). Subjects were assessed for five learning outcomes including knowledge and image interpretation, practical performance of echocardiography including time taken to obtain a diagnostic view, integration into the ALS algorithm and overall compliance with established resuscitation guidelines. Results: There was a significant improvement in knowledge and interpretation of echocardiographic images before and after completion of the one-day course (pre 62%, post 78%, p < 0.01). Skills acqui-sition resulted in 100% of participants being able to obtain a subcostal view of diagnostic quality by the end of the course, and 86% with a mean time to acquisition of <10 s. On completion of the training programme, incorporation of echocardiography into current resuscitation practice did not compromise ALS-compliance. Conclusion: Novice echocardiographers can obtain knowledge and skills relevant to ALS-compliant peri-resuscitation echocardiography using a range of educational techniques. In addition to the standard one-day training courses available, continued mentored practice and didactic adherence to ALS algorithms is required.
[Show abstract][Hide abstract] ABSTRACT: We describe a training programme for non-specialists in focused echocardiography in the periresuscitation setting which represents an entry level in echocardiography training (FEEL) for emergency and critical care medicine physicians.
A prospective observational study based upon the development of a periresuscitation echocardiography training programme developed for novice practitioners (N=15 courses).
The programme enables novice echocardiographers to be able to perform a focused echocardiogram in an ALS-compliant manner, and interpret the findings in the context of the clinical scenario. It is based on the concept of blended learning, incorporating a combination of e-learning, web-based teaching and reading selected literature, and attendance at a course. The course comprises 4-hours of theory and 4-hours of hands-on training.
Periresuscitation echocardiography, performed safely, within the competence of practitioners in an ALS-compliant manner is a potentially valuable skill to be acquired by physicians caring for the critically ill, regardless of the environment in which they work, or their level of seniority. This newly-developed blended learning periresuscitation echocardiography programme (FEEL) may serve as entry level in peri-resuscitation echocardiography for both emergency physicians and critical care practitioners.