*Dalhousie University,Saint John, NB.
‡Sydney Adventist Hospital,Wahroonga,Australia.
CJEM. 2017 Nov;19(6):459-470. doi: 10.1017/cem.2016.394. Epub 2016 Dec 21.
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.
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.
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.
An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
引言 国际急救医学联合会（IFEM）超声特别兴趣小组（USIG）负责制定一种分层共识方法，以在低血压和心搏骤停患者中使用即时床旁超声（PoCUS）。
IFEM USIG 邀请了 24 位来自急救医学和重症监护领域的公认的 PoCUS 国际领导者组成专家小组，制定低血压和心搏骤停中的超声（SHoC）方案。该小组提供了报告的疾病发生率，以及之前发布的协议和指南中推荐的 PoCUS 视图列表。该小组使用改良 Delphi 方法，负责整合疾病发生率、他们的临床经验和他们对医学文献的了解，以评估每个视图在拟议的 SHoC 方案中应发挥的作用。
在经过三轮改良 Delphi 过程后，达成了关于 SHoC 方案的低血压和心搏骤停的共识。最终的 SHoC 方案和操作员检查表获得了超过 80%的共识批准。IFEM 批准的最终方案推荐了核心、补充和附加的 PoCUS 视图。SHoC-低血压的核心视图包括心脏、肺部和下腔静脉（IVC）视图，以及补充的心脏视图，以及在临床需要时的附加视图。建议在 SHoC-心搏骤停时使用 Subxiphoid 或胸骨旁心脏视图，尽量减少胸外按压的暂停，作为核心视图；补充视图为肺部和 IVC，在临床需要时附加视图。两个方案都建议使用“4 F”方法：液体、形态、功能、填充。
提出了关于低血压和心搏骤停超声的国际共识。需要进行未来的前瞻性验证。
