Cooper University Hospital, Department of Medicine, Division of Pulmonary, Allergy & Critical Care, Camden, New Jersey.
Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California.
West J Emerg Med. 2021 Jul 20;22(4):803-809. doi: 10.5811/westjem.2021.4.50205.
Point-of-care (POC) echocardiography (echo) is a useful adjunct in the management of cardiac arrest. However, the practice pattern of POC echo utilization during management of cardiac arrest cases among emergency physicians (EP) is unclear. In this pilot study we aimed to characterize the utilization of POC echo and the potential barriers to its use in the management of cardiac arrest among EPs.
This was a cross-sectional survey of attending EPs who completed an electronic questionnaire composed of demographic variables (age, gender, year of residency graduation, practice setting, and ultrasound training) and POC echo utilization questions. The first question queried participants regarding frequency of POC echo use during the management of cardiac arrest. Branching logic then presented participants with a series of subsequent questions regarding utilization and barriers to use based on their responses.
A total of 155 EPs participated in the survey, with a median age of 39 years (interquartile range 31-67). Regarding POC echo utilization, participants responded that they always (66%), sometimes (30%), or never (4.5%) use POC echo during cardiac arrest cases. Among participants who never use POC echo, 86% reported a lack of training, competency, or credentialing as a barrier to use. Among participants who either never or sometimes use POC echo, the leading barrier to use (58%) reported was a need for improved competency. Utilization was not different among participants of different age groups (P = 0.229) or different residency graduation dates (P = 0.229). POC echo utilization was higher among participants who received ultrasound training during residency (P = 0.006) or had completed ultrasound fellowship training (P <0.001) but did not differ by gender (P = 0.232), or practice setting (0.231).
Only a small minority of EPs never use point-of-care echocardiography during the management of cardiac arrest. Lack of training, competency, or credentialing is reported as the leading barrier to use among those who do not use POC echo during cardiac arrest cases. Participants who do not always use ultrasound are less likely to have received ultrasound training during residency.
床边超声心动图（POC 超声）在心脏骤停的管理中是一种有用的辅助手段。然而，急诊医师（EP）在管理心脏骤停病例时使用 POC 超声的实际情况尚不清楚。在这项初步研究中，我们旨在描述 EP 在管理心脏骤停病例时使用 POC 超声的情况，并确定其使用的潜在障碍。
这是一项横断面调查，调查对象为参加电子问卷调查的主治 EP，问卷内容包括人口统计学变量（年龄、性别、住院医师毕业年份、执业地点和超声培训）和 POC 超声使用情况。第一个问题是询问参与者在管理心脏骤停期间使用 POC 超声的频率。然后根据参与者的回答，分支逻辑向他们提出一系列关于使用情况和使用障碍的后续问题。
共有 155 名 EP 参加了调查，年龄中位数为 39 岁（四分位距 31-67 岁）。关于 POC 超声的使用情况，参与者回答他们在心脏骤停病例中总是（66%）、有时（30%）或从不（4.5%）使用 POC 超声。在从不使用 POC 超声的参与者中，86%表示缺乏培训、能力或认证是使用的障碍。在从不或有时使用 POC 超声的参与者中，使用的主要障碍（58%）是需要提高能力。不同年龄组（P = 0.229）或不同住院医师毕业日期（P = 0.229）的参与者之间的使用情况没有差异。在接受住院医师培训期间接受超声培训（P = 0.006）或完成超声研究金培训（P <0.001）的参与者中，POC 超声的使用率较高，但与性别（P = 0.232）或执业地点（P = 0.231）无关。
只有少数 EP 在管理心脏骤停时从不使用床边超声心动图。在那些在心脏骤停病例中不使用 POC 超声的人中，缺乏培训、能力或认证被报告为使用的主要障碍。那些不经常使用超声的人在住院医师培训期间接受超声培训的可能性较小。
