Division of Haematology/Oncology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Department of Anesthesia and Pain Management, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
Pediatr Blood Cancer. 2021 Jul;68(7):e29015. doi: 10.1002/pbc.29015. Epub 2021 Mar 25.
Ultrasound assistance improves success rates and reduces adverse outcomes of lumbar punctures (LPs) among adult patients in the emergency room and the operating room, but has not been evaluated in pediatric patients with cancer. Our objectives were (1) to determine whether pediatric oncologists could perform ultrasound-assisted LPs following a structured teaching curriculum, and (2) to determine the feasibility of recruiting pediatric cancer patients to a clinical trial of this procedure.
Three pediatric oncologists completed a curriculum composed of didactic teaching followed by hands-on workshops. Each learner was evaluated during 20 attempts at three ultrasound tasks using the cumulative sum method. The three pediatric oncologists then performed ultrasound assessments prior to routinely scheduled LPs. Feasibility was defined as ability to perform at least 30 ultrasound-assisted LPs within 6 months. Secondary outcomes were the proportion of successful, bloody, or traumatic LPs, time required, and perceived helpfulness of ultrasound.
All three pediatric oncologists achieved competence in the three tasks of ultrasound scanning within 20 evaluated attempts. We recruited 62 patients within 1 month, and 58 underwent an ultrasound-assisted LP. All LPs were successful. Two LPs (4%) had ≥500 red blood cells (RBCs)/μl, and nine (16%) had ≥10 RBCs/μl. Median time to conduct the scan was 1.9 minutes (range 0.8-4.0 minutes). In 37 (64%) of the LPs, ultrasound assistance was considered helpful or very helpful.
Pediatric oncologists readily achieved competence in ultrasound-assisted LPs, and ultrasound was commonly perceived as helpful. It is feasible to proceed to a randomized trial of this procedure in pediatric cancer.
超声辅助可提高成人在急诊室和手术室行腰椎穿刺（LP）的成功率并降低不良事件发生率，但尚未在儿科癌症患者中进行评估。我们的目标是：（1）确定儿科肿瘤学家是否可以在接受结构化教学课程后进行超声辅助 LP；（2）确定招募儿科癌症患者参加该程序临床试验的可行性。
3 名儿科肿瘤学家完成了由理论授课和实操课程组成的课程。每位学习者在三个超声任务的 20 次尝试中都使用累计和方法进行了评估。然后，这 3 名儿科肿瘤学家在常规计划 LP 之前进行了超声评估。可行性定义为在 6 个月内完成至少 30 次超声辅助 LP 的能力。次要结局是成功、血性或创伤性 LP 的比例、所需时间以及对超声的感知帮助。
所有 3 名儿科肿瘤学家在 20 次评估尝试中均熟练掌握了三种超声扫描任务。我们在 1 个月内招募了 62 名患者，其中 58 名患者接受了超声辅助 LP。所有 LP 均成功。2 次 LP（4%）有≥500 个红细胞（RBC）/μl，9 次（16%）有≥10 个 RBC/μl。进行扫描的中位时间为 1.9 分钟（范围 0.8-4.0 分钟）。在 37 次（64%）LP 中，超声辅助被认为有帮助或非常有帮助。
儿科肿瘤学家很快掌握了超声辅助 LP 的技能，且超声通常被认为是有帮助的。在儿科癌症中进行该程序的随机试验是可行的。
