Abstract
IntroductionUltrasound hypotension protocols (UHP) involve imaging multiple body areas, each with different transducers and imaging presets. The time for task switching between presets and transducers to perform an UHP has not been previously studied. A novel hand-carried ultrasound (HCU) has been developed that uses a multifrequency single transducer to image areas of the body (lung, heart, abdomen, superficial) that would typically require three transducers using a traditional cart-based ultrasound (CBU) system. Our primary aim was to compare the time to complete UHPs with a single transducer HCU to a multiple transducer CBU.MethodsWe performed a randomized, crossover feasibility trial in the emergency department of an urban, safety-net hospital. This was a convenience sample of non-hypotensive emergency department patients presenting during a two-month period of time. Ultrasound hypotension protocols were performed by emergency physicians (EP) on patients using the HCU and the CBU. The EPs collected UHP views in sequential order using the most appropriate transducer and preset for the area/organ to be imaged. Time to complete each view, time for task switching, total time to complete the examination, and image diagnostic quality were recorded.ResultsA total of 29 patients were scanned by one of eight EPs. When comparing the HCU to the CBU, the median time to complete the UHP was 4.3 vs 8.5 minutes (P <0.0001), respectively. When the transport and plugin times were excluded, the median times were 4.1 vs 5.8 minutes (P <0.0001), respectively. There was no difference in the diagnostic quality of images obtained by the two devices.ConclusionUltrasound hypotension protocols were performed significantly faster using the single transducer HCU compared to a multiple transducer CBU with no difference in the number of images deemed to be diagnostic quality.
Highlights
Ultrasound hypotension protocols (UHP) involve imaging multiple body areas, each with different transducers and imaging presets
Ultrasound hypotension protocols were performed significantly faster using the single transducer hand-carried ultrasound (HCU) compared to a multiple transducer cart-based ultrasound (CBU) with no difference in the number of images deemed to be diagnostic quality. [West J Emerg Med. 2021;22(3)775–781.]
There was no significant difference in the number of images judged by the emergency sonographer to be diagnostic quality obtained by the two devices, there was a slight increase in the number of diagnostic-quality images from the parasternal long axis cardiac and inferior vena cava (IVC) views with the CBU device and the four-chamber cardiac and aorta views with the HCU device (Table 2)
Summary
Ultrasound hypotension protocols (UHP) involve imaging multiple body areas, each with different transducers and imaging presets. The rapid ultrasound for shock and hypotension (RUSH) examination is a scanning protocol that involves imaging the chest, heart, peritoneal cavity, abdominal aorta, inferior vena cava (IVC), and leg veins to determine the etiology of different shock states.[4] Similar ultrasound hypotension protocols (UHP) have been shown to improve outcomes, enhance diagnostic certainty, and change patient management.[2,5,6,7] For example, Haydar et al found that incorporating an UHP involving multiple views of the heart and IVC altered more than half of physicians’ management decisions, while 90% perceived the ultrasound data to have positive clinical utility.[5] Shokoohi et al used an UHP involving a focused cardiac assessment, measurement of IVC collapsibility, an assessment of the abdominal cavity for free fluid or abdominal aortic aneurysm, and a thoracic scan to evaluate for pneumothorax, which changed management in 24.6% of hypotensive patients while decreasing diagnostic complexity by 27.4%.6
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