title: International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest.
abstract: Introduction The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest.
  
  
  METHODS
  The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol.
  
  
  RESULTS
  Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the "4 F" approach: fluid, form, function, filling.
  
  
  CONCLUSIONS
  An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
authors.affiliation: *Dalhousie University,Saint John, NB.
authors.forename: Paul
authors.initials: P
authors.lastname: Atkinson
authors.affiliation: ‡Sydney Adventist Hospital,Wahroonga,Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Bowra
authors.affiliation: ¶Fraser Health Authority,Surrey, BC.
authors.forename: James
authors.initials: J
authors.lastname: Milne
authors.affiliation: *Dalhousie University,Saint John, NB.
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.affiliation: **Advocate Christ Medical Centre,Oak Lawn, IL.
authors.forename: Mike
authors.initials: M
authors.lastname: Lambert
authors.affiliation: †††Barts Health NHS Trust,London,UK.
authors.forename: Bob
authors.initials: B
authors.lastname: Jarman
authors.affiliation: §§University Hospitals Cleveland Medical Center,Cleveland, OH.
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
authors.affiliation: ***Stellenbosch University,Stellenbosch,South Africa.
authors.forename: Hein
authors.initials: H
authors.lastname: Lamprecht
authors.affiliation: †††Barts Health NHS Trust,London,UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Harris
authors.affiliation: ††Royal Victoria Infirmary,Newcastle upon Tyne,UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Connolly
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D032921:Consensus; D004635:Emergency Medicine / Q000592:standards*; D006323:Heart Arrest / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology*; D019095:Point-of-Care Systems / Q000458:organization & administration*; D014463:Ultrasonography
keywords: hypotension; life support; shock; ultrasound