title: Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study.
abstract: OBJECTIVE
  To determine the feasibility of using the Ultrasound Cardiac Output Monitor (USCOM) as an adjunct during hemodynamic assessments by a pediatric medical emergency team (PMET).
  
  
  METHODS
  Pediatric in-patients at McMaster Children's Hospital aged under 18 years requiring urgent PMET consultation, were eligible. Patients with known cardiac outflow valve defects, Pediatric Critical Care Unit in-patients, and those in cardiorespiratory arrest, were excluded. The primary outcome was feasibility, and the ease of USCOM transport and application as assessed by a self-administered user questionnaire. Secondary outcomes included the quality of USCOM measurements, and agreement in clinical versus USCOM-derived assessments.
  
  
  RESULTS
  Forty-one patients from 85 eligible PMET consultations were enrolled between March and August 2011. A total of 55 USCOM assessments were performed on 36 of 41 (87.8%) participants. USCOM could not be completed in 5 (12.2%) participants due to patient agitation (n = 4) and emergent care (n = 1). USCOM was reported as easy to transport and apply by 97.4% and 94.7% of respondents respectively, not obstructive to patient care by 94.7%, and yielded timely measurements by 84.2% respondents. USCOM tracings were of good quality in 41 (75.9%) assessments. Agreement between clinical and USCOM-derived hemodynamic assessments by two independent raters was poor (Rater 1: κ = 0.094; Rater 2: κ = 0.146).
  
  
  CONCLUSIONS
  USCOM can be applied by a PMET during urgent hemodynamic assessments in children. While USCOM has been validated in stable children, its role in guiding hemodynamic resuscitation and informing therapeutic goals in a hemodynamically unstable pediatric population requires further investigation.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: David J
authors.initials: DJ
authors.lastname: Zorko
authors.forename: Karen
authors.initials: K
authors.lastname: Choong
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gilleland
authors.forename: Barbara
authors.initials: B
authors.lastname: Agar
authors.forename: Shawn
authors.initials: S
authors.lastname: Baker
authors.forename: Cindy
authors.initials: C
authors.lastname: Brennan
authors.forename: Eleanor
authors.initials: E
authors.lastname: Pullenayegum
mesh_terms: D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010820:Physicians; D010865:Pilot Projects; D013997:Time Factors; D014465:Ultrasonics