Germanoska Biljana, Coady Matthew, Ng Sheyin, Fermanis Gary, Miller Matthew
St George Hospital, Kogarah, Australia.
Ambulance Service of New South Wales, Rozelle, Australia.
Ultrasound. 2018 May;26(2):118-126. doi: 10.1177/1742271X17753467. Epub 2018 Jan 29.
Manual palpation of pulses is unreliable in detecting pulsatile flow in human participants, complicating the assessment of return of spontaneous circulation after cardiac arrest. Ultrasound may offer an alternative. This study's objective was to investigate whether return of pulsatile flow in humans can be reliably assessed by common carotid artery ultrasound. We conducted a single-blinded randomised study of common carotid artery ultrasound using 20 cardiopulmonary bypass patients to model the return of pulsatile flow. Synchronised time-stamped videos of radial artery invasive blood pressure and 10 two-dimensional or 10 colour Doppler ultrasounds were recorded. Three independent reviewers recorded the timestamp where they considered pulsatile flow was first visible on ultrasound. Ultrasound times were compared to the onset of arterial line pulsatile flow and reliability assessed by intraclass correlation coefficient. The median difference between radial artery and ultrasound flow time (interquartile range (range)) was 24 seconds (5-40 (0-93)) for two-dimensional and 5 seconds (2-17 (-28 to 188)) for colour Doppler. The intraclass correlation coefficient for two-dimensional ultrasound was 0.86 (95%CI 0.63-0.96) and 0.32 (95%CI -0.01 to 0.71) for colour Doppler. The median (interquartile range (range)) mean arterial pressure where ultrasound flow occurred for two-dimensional ultrasound was 62 mmHg (49-74 (33-82)) and 56 mmHg (52-73 (43-83)) for colour Doppler. In our pilot study, two-dimensional ultrasound was reliable in detecting the return of pulsatile flow. Colour Doppler detected pulsatile flow earlier and at lower mean arterial pressure but was not reliable, although a larger study is needed to determine colour Doppler's utility.
在检测人体参与者的搏动性血流时，手动触诊脉搏不可靠，这使得心脏骤停后自主循环恢复的评估变得复杂。超声检查可能是一种替代方法。本研究的目的是调查能否通过颈总动脉超声可靠地评估人体搏动性血流的恢复情况。我们对20名接受体外循环的患者进行了一项关于颈总动脉超声的单盲随机研究，以模拟搏动性血流的恢复。记录了桡动脉有创血压的同步时间戳视频以及10个二维或10个彩色多普勒超声图像。三名独立的评估人员记录了他们认为超声上首次可见搏动性血流的时间戳。将超声检查时间与动脉管路搏动性血流的起始时间进行比较，并通过组内相关系数评估可靠性。二维超声检查时，桡动脉血流时间与超声血流时间的中位数差异（四分位间距（范围））为24秒（5 - 40（0 - 93）），彩色多普勒超声检查时为5秒（2 - 17（-28至188））。二维超声的组内相关系数为0.86（95%置信区间0.63 - 0.96），彩色多普勒超声的组内相关系数为0.32（95%置信区间 - 0.01至0.71）。二维超声检查出现血流时的平均动脉压中位数（四分位间距（范围））为62 mmHg（49 - 74（33 - 82）），彩色多普勒超声检查时为56 mmHg（52 - 73（43 - 83））。在我们的初步研究中，二维超声在检测搏动性血流恢复方面是可靠的。彩色多普勒超声能更早且在更低的平均动脉压下检测到搏动性血流，但不可靠，不过需要更大规模的研究来确定彩色多普勒超声的效用。
