Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial.
OBJECTIVE
Focused ultrasound is increasingly used in the emergency setting, with an ALS-compliant focused echocardiography algorithm proposed as an adjunct in peri-resuscitation care (FEEL). The purpose of this study was to evaluate the feasibility of FEEL in pre-hospital resuscitation, the incidence of potentially treatable conditions detected, and the influence on patient management.


METHODS
A prospective observational study in a pre-hospital emergency setting in patients actively undergoing cardio-pulmonary resuscitation or in a shock state. The FEEL protocol was applied by trained emergency doctors, following which a standardised report sheet was completed, including echo findings and any echo-directed change in management. These reports were then analysed independently.


RESULTS
A total of 230 patients were included, with 204 undergoing a FEEL examination during ongoing cardiac arrest (100) and in a shock state (104). Images of diagnostic quality were obtained in 96%. In 35% of those with an ECG diagnosis of asystole, and 58% of those with PEA, coordinated cardiac motion was detected, and associated with increased survival. Echocardiographic findings altered management in 78% of cases.


CONCLUSIONS
Application of ALS-compliant echocardiography in pre-hospital care is feasible, and alters diagnosis and management in a significant number of patients. Further research into its effect on patient outcomes is warranted.
Breitkreutz
Raoul
R
Department of Anaesthesiology, Intensive Care and Pain Therapy University of the Saarland, Medical Faculty, D-66421 Homburg (Saar), Germany. raoul.breitkreutz@gmail.com
Price
Susanna
S
Steiger
Holger V
HV
Seeger
Florian H
FH
Ilper
Hendrik
H
Ackermann
Hanns
H
Rudolph
Marcus
M
Uddin
Shahana
S
Weigand
Markus A
MA
Müller
Edgar
E
Walcher
Felix
F
D022561:Advanced Cardiac Life Support / Q000379:methods*; D000368:Aged; D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004452:Echocardiography; D004632:Emergency Medical Services / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome