Leviter Julie I, Chen Lei, O'Marr Jamieson, Riera Antonio
From the Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine.
Yale University School of Medicine, New Haven, CT.
Pediatr Emerg Care. 2023 May 1;39(5):347-350. doi: 10.1097/PEC.0000000000002741. Epub 2022 Apr 25.
Resuscitation guidelines emphasize minimal interruption of compressions during cardiopulmonary resuscitation. Point-of-care ultrasound (POCUS) enables the clinician to visualize cardiac contractility and central artery pulsatility. The apical 4-chamber (A4), subxiphoid (SX), and femoral artery views may be used when defibrillator pads or active compressions preclude parasternal cardiac views. We hypothesized that clinicians can rapidly obtain interpretable POCUS views in healthy children from the A4, SX, and femoral positions.
A prospective study of pediatric emergency medicine providers in an urban academic hospital was performed. Stable patients of 12 years or younger were scanned. Sonologists were each allotted 10 seconds to acquire A4, SX, and femoral views. Two attempts at each view were allowed. The primary outcome was whether cardiac and femoral artery scans were interpretable for contractility and pulsatility, respectively. The secondary outcome was whether cardiac scans were interpretable for effusion or right ventricular strain. A POCUS expert reviewed scans to confirm interpretability.
Twenty-two sonologists performed a total of 50 scans on 22 patients. A view that was interpretable for contractility was obtained on the first attempt in 86% of A4 and 94% of SX scans. A femoral view that was interpretable for pulsatility was obtained on the first attempt in 74% of scans. Expert review was concordant with sonologist interpretation.
Pediatric emergency medicine physicians can obtain interpretable cardiac and central artery views within 10 seconds most of the time. Point-of-care ultrasound has the potential to enhance care during pediatric resuscitation. Future studies on the impact of POCUS pulse checks in actual pediatric resuscitations should be performed.
复苏指南强调在心肺复苏过程中尽量减少按压中断。床旁超声（POCUS）使临床医生能够可视化心脏收缩力和中心动脉搏动。当除颤器电极片或持续按压妨碍胸骨旁心脏视图时，可使用心尖四腔心（A4）、剑突下（SX）和股动脉视图。我们假设临床医生能够在健康儿童中从A4、SX和股动脉位置快速获得可解读的POCUS视图。
在一家城市学术医院对儿科急诊医学提供者进行了一项前瞻性研究。对12岁及以下的稳定患者进行扫描。每位超声科医生被分配10秒钟来获取A4、SX和股动脉视图。每个视图允许尝试两次。主要结果是心脏和股动脉扫描是否分别可解读收缩力和搏动。次要结果是心脏扫描是否可解读积液或右心室应变。一名POCUS专家审查扫描结果以确认可解读性。
22名超声科医生对22名患者共进行了50次扫描。在86%的A4扫描和94%的SX扫描中，首次尝试就获得了可解读收缩力的视图。在74%的扫描中，首次尝试就获得了可解读搏动的股动脉视图。专家审查与超声科医生的解读一致。
儿科急诊医学医生大多数时候能够在10秒内获得可解读的心脏和中心动脉视图。床旁超声有潜力在儿科复苏期间改善护理。未来应开展关于POCUS脉搏检查在实际儿科复苏中影响的研究。
