629 Point-of-Care Ultrasound Improves Aspiration Risk Assessment for Anesthesia in Upper GI Bleeding: A Prospective Study

Abstract

INTRODUCTION: Gastric contents can be identified using point-of-care ultrasound prior to administration of anesthesia as part of a risk assessment tool to prevent aspiration however its clinical use is still being explored. We investigated the utility of US immediately prior to EGD in patients with suspected upper GI bleeding and its effect on anesthesia management. METHODS: We performed a prospective observational study of 30 patients undergoing EGD for upper GI bleeding at a large tertiary care center. All patients underwent a 2-5 minute US assessing antral contents in the endoscopy suite. EGD was then performed and actual gastric contents was assessed. A decision to proactively intubate was made prior to US findings and adjusted accordingly at the discretion of the anesthesiologist depending on US results. Outcomes included the confirmation of US results with EGD findings, aspiration events, intubation decisions, need for escalation of care, successful EGD intervention, and mortality. RESULTS: All 30 patients had US results that correlated directly with EGD findings. A total of 26 of the 30 patients (86.7%) were found to have negative US findings and all were found to have empty stomachs on EGD. 7 of these 26 (26.9%) presented initially with hematemesis. A total of 4 of the 30 patients (13.3%) had positive US findings and all were confirmed to have old or fresh blood seen immediately upon entering the stomach on EGD. Additionally, 5 of the 30 patients had US findings that altered anesthesia management preprocedure. Of these, 4 patients had empty stomach findings on US and thus were not intubated. All 4 had successful endoscopic interventions without aspiration events. The other 1 patient was unexpectedly found to have a full stomach on US and thus was electively intubated. The patient was found to have significant blood and clot in the stomach due to an underlying ulcer which was treated successfully. The patient was extubated post procedure without any aspiration event. CONCLUSION: In a prospective observational study, point-of-care US use prior to EGD was found to be accurate and effective in determining gastric contents and aided in preprocedural decision-making to help prevent aspiration events. To our knowledge, this is the first prospective study assessing this question and is a proof of concept that US is a viable risk assessment tool for patients with upper GI bleeding undergoing EGD.