Table 1 Included studies exclusively examining one of the first hour quintet patient groups

 Aichinger, 2012

Prospective, observational (cohort)

To evaluate the ability of heart US to predict outcome in cardiac arrest

Heart (cardiac standstill y/n)

Novice physicians

Feasibility 100%. 1/32 patients with cardiac standstill vs. 4/10 patients with cardiac movement survived to hospital discharge (p = 0,008). Cardiac standstill 97.1% PPV for death at scene.

 Reed, 2017

Prospective, observational (cohort)

To evaluate the ability of paramedics to perform heart US during pulse check

Heart

Extensively trained paramedics

Adequate view in first attempt in 80% of patients, but prolonged pauses in compressions – median 17 s (IQR 13–20).

 Rooney, 2016

Cohort

To determine if paramedics could perform cardiac ultrasound in the field and correctly identify cardiac activity/standstill

Heart

Novice paramedics

A total of 17/19 (89, 95% CI 67–99) exams were adequate for clinical decision-making. Correct identification of 17/17 cases of cardiac activity and 2/2 cases of cardiac standstill.

 No studies

 Herzberg, 2014

Diagnostic accuracy

To evaluate the accuracy of transcranial US for neurovascular emergency diagnostics

Transcranial color-coded US in combination with clinical examination

Experienced neurologists

Any stroke: sensitivity 94%, specificity 48%

Major stroke: sensitivity 78%, specificity 98%

 Neesse, 2012

Diagnostic accuracy

To evaluate the feasibility and diagnostic value of a chest ultrasound algorithm in dyspnea

Heart, anterior lungs, dorsolateral pleura

Certified physicians

US helpful tool in 38/56 (68%) patients, additional therapeutic consequences drawn in 14/56 (25%). Pleural effusion found to be a 100% sensitive marker for congestive heart failure.

 Laursen, 2016

Diagnostic accuracy

To assess feasibility, time-use and diagnostic accuracy of lung ultrasound for cardiogenic pulmonary edema

Anterior and lateral part of the lungs (4 regions, B-lines only)

Novice physicians

Feasibility 100%. Median time used 3 min.

Sensitivity 94% (CI 73–100), specificity 77% (CI 55–92), PPV 77% (CI 55–92), NPV 94% (CI 73–100)

 Strnad, 2016

Prospective, observational

(cohort)

To determine the usefulness of lung ultrasound in treatment monitoring with CPAP vs standard treatment in CHF

Anterior and lateral part of the lungs (15 regions), B-lines only.

Physicians

Lower total number of B-lines after than before CPAP (p < 0.001). Percentage of positive US lung scans significantly reduced in several regions in the CPAP group. Changes in B-lines correlated with improved vital signs.

 Brun, 2014

Cluster-randomized

(controlled)

To compare the feasibility and efficiency of eFAST on-site, during transfer, or both

Lungs, heart, abdomen (PTX, tamponade, hemothorax, hemoperitoneum y/n)

Physicians, heterogenous experience

On-site: feasibility 95.4%, efficiency 95%

During transfer: feasibility 93.9%, efficiency 97%

Both: feasibility 95.2%, efficiency 100%

No difference between groups (w = 0.68)

 Press, 2014

Diagnostic accuracy

To determine the accuracy of each component of trauma ultrasound performed by HEMS providers

Lungs, heart, abdomen (PTX, tamponade, hemothorax, hemoperitoneum y/n)

Flight nurses/paramedics

Hemoperitoneum: sensitivity 46% (CI 27–94), specificity 94% (CI 89–97). Laparotomy: sensitivity 65% (CI 39–85), specificity 94%(CI 89–97). Pneumothorax: sensitivity 19% (CI 9–34), specificity 99.5% (CI 98.2–99.9). Thoracostomy: sensitivity 50% (CI 22–59), specificity 99.8% (CI 98.6–100)

 Yates, 2017

Observational, controlled

To correlate prehospital trauma ultrasound findings to inhospital trauma team findings

Lungs, heart, abdomen (PTX, tamponade, hemothorax, hemoperitoneum y/n).

Flight nurses/paramedics

PPV 100%

NPV 98.3%

Equivalent to in-hospital trauma team ultrasound