Skip to main content

Advertisement

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

From: The role of point of care ultrasound in prehospital critical care: a systematic review

First author, year n Study type Aim US types, providers Main results Rating
Cardiac arrest only
 Aichinger, 2012 42 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 45 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 19 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. +
Chest pain
 No studies       
Suspected stroke
 Herzberg, 2014 102 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%
0
Breathing difficulties
 Neesse, 2012 56 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 40 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 20 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. 0
Trauma
 Brun, 2014 98 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 293 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 190 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
0
  1. Abbreviations: US ultrasound, PPV positive predictive value, IQR interquartile range, CI confidence interval, NPV negative predictive value, CPAP continuous positive airway pressure ventilation, PTX pneumothorax
  2. Rating scale: ++ High quality, + Acceptable, − Low quality/unacceptable, 0 Rejected