Morales Gabriel, Adedipe Adeyinka, Morse Sophie, McCabe James, Mahr Claudius, Nichol Graham
Department of Emergency Medicine, University of Washington, Seattle, USA.
Department of Medicine, Division of Cardiology, University of Washington, Seattle, USA.
Cureus. 2022 Oct 31;14(10):e30927. doi: 10.7759/cureus.30927. eCollection 2022 Oct.
Background Cardiogenic shock (CS) is critical end-organ hypoperfusion due to reduced cardiac output. Early therapy, such as vasoactive agents or the initiation of mechanical circulatory support (MCS), requires early diagnosis and is associated with better outcomes. A novel ultrasound platform (GE Healthcare, Milwaukee, WI) has semi-automated imaging software (SAIS), which could simplify the point-of-care ultrasound (POCUS) diagnosis of CS. We assessed the feasibility of using POCUS with SAIS in patients in shock, determined the ability of SAIS to identify the subset of patients with CS, and described the process and outcome of care of patients with vs. without CS after presenting to Emergency Department (ED) with hypotension. Methods This prospective case-control study was conducted at an urban ED. Physicians with prior POCUS education received one hour of training with the study device. The qualitative ejection fraction was determined by visual assessment. SAIS measurements of hemodynamics were made with the study device and included left ventricle outflow tract velocity time integral (LVOT VTI), inferior vena cava collapsibility or distensibility indices, and pulmonary B-line assessment. ED patients with a systolic blood pressure ≤ 90 mmHg or need for a vasopressor initiation in the ED were enrolled. The diagnosis of CS was determined by a medical record review. All data were summarized descriptively. Results Twenty-nine cases underwent POCUS, and 87 controls did not. Baseline characteristics, process, and outcome of care were similar between groups. Seventy-nine percent (79%) of cases had a complete POCUS with SAIS. Of these, 55% had reduced LVOT VTI, 38% had IVC collapsibility <50%, and 48% of cases had a B-line pattern consistent with pulmonary edema. The mean LVOT VTI for cases with CS was 9.4± 5.4 cm; the mean LVOT VTI for cases without CS was 15.2 ± 6.0 cm. Among patients who did not undergo POCUS, 31 (36%) had a formal echocardiogram, and eight (9%) had a final diagnosis of cardiogenic shock during hospitalization. Conclusion Physicians with one hour of platform-specific training were able to implement POCUS with SAIS among patients who present with shock. POCUS with SAIS may aid in the early recognition of CS.
心源性休克（CS）是由于心输出量减少导致的严重终末器官灌注不足。早期治疗，如使用血管活性药物或启动机械循环支持（MCS），需要早期诊断，且与更好的预后相关。一种新型超声平台（通用电气医疗集团，威斯康星州密尔沃基）具有半自动成像软件（SAIS），它可以简化CS的床旁超声（POCUS）诊断。我们评估了在休克患者中使用带有SAIS的POCUS的可行性，确定了SAIS识别CS患者亚组的能力，并描述了低血压患者到急诊科（ED）就诊后有CS与无CS患者的治疗过程和结果。
这项前瞻性病例对照研究在一家城市急诊科进行。接受过POCUS培训的医生使用研究设备接受了一小时的培训。通过视觉评估确定定性射血分数。使用研究设备进行SAIS血流动力学测量，包括左心室流出道速度时间积分（LVOT VTI）、下腔静脉塌陷或扩张指数以及肺B线评估。纳入收缩压≤90 mmHg或在急诊科需要启动血管升压药的ED患者。通过病历审查确定CS的诊断。所有数据均进行描述性总结。
29例患者接受了POCUS检查，87例对照未接受。两组之间的基线特征、治疗过程和结果相似。79%的病例使用SAIS进行了完整的POCUS检查。其中，55%的患者LVOT VTI降低，38%的患者下腔静脉塌陷度<50%，48%的病例有与肺水肿一致的B线模式。CS患者的平均LVOT VTI为9.4±5.4 cm；无CS患者的平均LVOT VTI为15.2±6.0 cm。在未接受POCUS检查的患者中，31例（36%）进行了正式超声心动图检查，8例（9%）在住院期间最终诊断为心源性休克。
接受一小时特定平台培训的医生能够在休克患者中使用带有SAIS的POCUS。使用SAIS的POCUS可能有助于早期识别CS。
