Abstract 17913: Performance of Emergency Ultrasound During Cardiopulmonary Resuscitation: Trained Residents versus Experienced Staff Doctors
Introduction: Emergency ultrasound during cardiopulmonary resuscitation (CPR) has attracted increasing attention. The 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend ultrasound use during CPR. Although accuracy of ultrasound generally depends on the skill and experience of the examiner, some evidences show that emergency physicians perform emergency ultrasound well enough with appropriate training.
Hypothesis: We hypothesized that well-trained residents perform emergency ultrasound during CPR as good as staff doctors in emergency departments.
Methods: We conducted a retrospective analysis of non-traumatic out-of-hospital cardiac arrest (OHCA) patients who were brought to an urban emergency department and underwent autopsy between 2010 and 2014 in Japan. To evaluate the diagnostic value of emergency ultrasound, we compared the results of emergency ultrasound performed by residents and staff doctors in the emergency department with autopsy-proven diagnoses.
Results: A total of 268 patients with non-traumatic OHCAs underwent autopsy (168 men [62.7%], 100 women [37.3%]; mean age, 71.3 ± 15 years). Of them, 202 patients (75.3%) were examined by emergency ultrasound. The most common cause of OHCA was acute coronary syndrome (72 cases, 36 %), followed by aortic pathology (21, 10%), arrhythmia (20, 10%), and pulmonary embolism (9, 4.6%). Emergency ultrasound identified the following causes of OHCA in 19 patients: cardiac tamponade (14 cases), abdominal/thoracic aortic aneurysm rupture (3), and pulmonary embolism (2).Emergency ultrasound performed by residents showed a sensitivity of 55.6% (95% confidence interval [95% CI] 40.3-60.1), specificity of 98.9% (95% CI 95.9-99.8), and overall accuracy of 91.7% (95% CI 86.7-93.2), whereas that performed by staff doctors showed a sensitivity of 56.3% (38.0-67.7), specificity of 95.6% (95% CI 91.3-98.3), and overall accuracy of 88.1% (95% CI 81.1-92.4); these values were not significantly different.
Conclusions: Emergency ultrasound had high accuracy for identifying reversible causes of OHCAs; moreover, the performance of emergency ultrasound by trained residents and experienced staff doctors may not differ.
Author Disclosures: Y. Matsuoka: None. N. Hata: None. D. Mizu: None. K. Ariyoshi: None.
- © 2016 by American Heart Association, Inc.