Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Erasmus University Medical Center Rotterdam, Department of Anesthesiology, Rotterdam, The Netherlands.
Prehosp Disaster Med. 2023 Aug;38(4):444-449. doi: 10.1017/S1049023X23006003. Epub 2023 Jul 17.
Several studies have shown the additional benefit of point-of-care ultrasound (POCUS) by prehospital Emergency Medical Services (EMS). Since organization of EMS may vary significantly across countries, the value of POCUS likely depends on the prehospital system in which it is used. In order to be able to optimally implement POCUS and develop a tailored training curriculum, it is important to know how often POCUS is currently used, for which indications it is used, and how it affects decision making. The aims of this study were: (1) to determine the percentage of patients in whom POCUS was used by Dutch Helicopter Emergency Medical Services (HEMS) crews; (2) to determine how often POCUS findings led to changes in on-scene management; and (3) what these changes were.
Patients who received prehospital care from December 1, 2020 through March 31, 2021 by a single HEMS crew were included in this prospective cohort study. Clinical data and specific data on POCUS examination, findings, and therapeutic consequences were collected and analyzed.
During the study period, on-scene HEMS care was provided to 612 patients, of which 211 (34.5%) patients underwent POCUS. Of these, 209 (34.2%) patients with a median age of 45 years were included. There were 131 (62.7%) trauma patients, and 70 (33.7%) of the included patients underwent cardiopulmonary resuscitation (CPR). The median reported time of POCUS examination was three (P-P 2-5) minutes. Median prolongation of on-scene time was zero (P-P 0-1) minutes. In 85 (40.7%) patients, POCUS examination had therapeutic consequence: POCUS was found to impact treatment decisions in 34 (26.0%) trauma patients and 51 (65.4%) non-trauma patients. In patients with cardiac arrest, POCUS was most often used to aid decision making with regard to terminating or continuing resuscitation (28 patients; 13.4%).
During the study period, POCUS examination was used in 34.5% of all prehospital HEMS patients and had a therapeutic consequence in 40.7% of patients. In trauma patients, POCUS seems to be most effective for patient triage and evaluation of treatment effectiveness. Moreover, POCUS can be of significant value in patients undergoing CPR. A tailored HEMS POCUS training curriculum should include ultrasound techniques for trauma and cardiac arrest.
多项研究表明，院前急救医疗服务（EMS）中的即时护理超声（POCUS）具有额外的益处。由于 EMS 的组织形式在各国之间可能存在显著差异，因此 POCUS 的价值可能取决于其使用的院前系统。为了能够优化 POCUS 的实施并制定量身定制的培训课程，了解 POCUS 当前的使用频率、使用指征以及它如何影响决策非常重要。本研究的目的是：（1）确定荷兰直升机急救医疗服务（HEMS）机组人员使用 POCUS 的患者比例；（2）确定 POCUS 检查结果导致现场管理变化的频率；以及（3）这些变化是什么。
本前瞻性队列研究纳入了 2020 年 12 月 1 日至 2021 年 3 月 31 日期间由单一 HEMS 机组提供的院前护理的患者。收集并分析了临床数据以及 POCUS 检查、结果和治疗后果的具体数据。
在研究期间，对 612 名患者进行了现场 HEMS 护理，其中 211 名（34.5%）患者接受了 POCUS。其中，209 名（34.2%）中位年龄为 45 岁的患者包括在内。其中 131 名（62.7%）为创伤患者，70 名（33.7%）纳入患者接受心肺复苏（CPR）。POCUS 检查的中位报告时间为 3 分钟（P-P 2-5）。中位现场时间延长为零分钟（P-P 0-1）。在 85 名（40.7%）患者中，POCUS 检查具有治疗效果：POCUS 检查影响 34 名（26.0%）创伤患者和 51 名（65.4%）非创伤患者的治疗决策。在心脏骤停患者中，POCUS 最常用于辅助决定是否终止或继续复苏（28 名患者；13.4%）。
在研究期间，POCUS 检查在所有院前 HEMS 患者中的使用率为 34.5%，在 40.7%的患者中具有治疗效果。在创伤患者中，POCUS 似乎最适合患者分诊和治疗效果评估。此外，POCUS 在接受 CPR 的患者中具有重要价值。量身定制的 HEMS POCUS 培训课程应包括创伤和心脏骤停的超声技术。
