Cardiac + Hemodynamics

BACKGROUND: We determine the predictive value of transthoracic echocardiographic (TTE) metrics for clinical deterioration within 5 days in adults with intermediate-risk pulmonary embolism (PE). METHODS: This was a prospective observational study of intermediate-risk PE patients. To determine associations of TTE and clinical predictors with clinical deterioration, we used univariable analysis, Youden's index for optimal thresholds, and multivariable analyses to report odds ratios (ORs) or area under the curve (AUC)...

OBJECTIVE: Handheld ultrasound devices (HUD) has diagnostic value in the assessment of patients with suspected left ventricular (LV) dysfunction. This meta-analysis evaluates the diagnostic ability of HUD compared with transthoracic echocardiography (TTE) and assesses the importance of operator experience. METHODS: MEDLINE and EMBASE databases were searched in October 2020. Diagnostic studies using HUD and TTE imaging to determine LV dysfunction were included. Pooled sensitivities and specificities, and summary receiver operating characteristic curves were used to determine the diagnostic ability of HUD and evaluate the impact of operator experience on test accuracy...

INTRODUCTION: Detection of a pulse is crucial to decision-making in the care of patients who are in cardiac arrest, however, the current standard of manual pulse palpation is unreliable. An emerging alternative is the use of point-of-care ultrasound (POCUS) for direct assessment of the carotid pulse. The primary objective of this study is to determine the interobserver reliability for physician interpretation of pre-recorded point-of-care ultrasound pulse-check clips for patients who are in cardiac arrest...

OBJECTIVES: Inferior vena cava collapsibility (cIVC) measured by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means of assessing fluid responsiveness. We aimed to prospectively evaluate the performance of a 25% cIVC cutoff value to detect fluid responsiveness among spontaneously breathing intensive care unit (ICU) patients when assessed with POCUS by novice versus expert physician sonologists. METHODS: Prospective observational study of spontaneously breathing ICU patients...

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BACKGROUND: A challenge for clinicians in emergency departments (EDs) is rapid identification of those patients with chest pain who require admission and urgent management and those with low clinical risk who can be discharged safely from the ED. This study was designed with an aim to evaluate the ability of two-dimensional transthoracic echocardiography (2D-TTE) to determine causes of acute chest pain in patients presenting to the ED in order to decide whether hospital admission and further investigations were needed...

OBJECTIVES: The primary objectives were to describe the diagnostic characteristics tricuspid annular plane systolic excursion (TAPSE) for pulmonary embolism (PE) and to optimize the measurement cutoff of TAPSE for the diagnosis of PE. Secondary objectives included assessment of interrater reliability and the quantitative visual estimation of TAPSE. METHODS: This is a prospective observational cohort study involving a convenience sample of patients at an urban academic emergency department...

OBJECTIVE: The study objective was to investigate the combined accuracy of right heart strain on focused cardiac ultrasound (FOCUS) and deep vein thrombosis (DVT) on compression ultrasound (CUS) for identification of centrally located pulmonary embolism (PE) diagnosed on computed tomography pulmonary angiography (CTPA). METHODS: This was a prospective observational study using a convenience sample of patients undergoing CTPA in the emergency department (ED) for evaluation of PE...

OBJECTIVE: To assess the effects of a cardiopulmonary ultrasound (CPUS) examination on diagnostic accuracy for critically ill patients in a resource-limited setting. METHODS: Approximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, were trained in a CPUS protocol. Adult patients triaged to the resuscitation area of the emergency department (ED) were enrolled if they exhibited signs or symptoms of shock or respiratory distress...

STUDY OBJECTIVE: Point-of-care ultrasonography protocols are commonly used in the initial management of patients with undifferentiated hypotension in the emergency department (ED). There is little published evidence for any mortality benefit. We compare the effect of a point-of-care ultrasonography protocol versus standard care without point-of-care ultrasonography for survival and clinical outcomes. METHODS: This international, multicenter, randomized controlled trial recruited from 6 centers in North America and South Africa and included selected hypotensive patients (systolic blood pressure <100 mm Hg or shock index >1) randomized to early point-of-care ultrasonography plus standard care versus standard care without point-of-care ultrasonography...

BACKGROUND: This study aims to compare the increased time needed to perform advanced focused cardiac measurements in the emergency department, including diastolic heart failure evaluation via E/E', and cardiac output with LVOT/VTI. Patients with pertinent cardiopulmonary symptoms in the emergency department had a focused cardiac ultrasound performed by the emergency department ultrasound team. The ability to obtain basic cardiac windows, evaluate for effusion, systolic ejection fraction, and right-sided heart pressures were recorded...

The presentation of cardiac tamponade is a spectrum from occult to extreme. The clinical history, physical exam, electrocardiogram, and radiographic findings of tamponade have poor sensitivities and even worse specificities. We use a clinical scenario to demonstrate how point-of-care cardiac ultrasound can diagnose impending cardiac tamponade in a clinically stable patient. The ultrasound finding we recommend is the flow velocity paradoxus, in which respiratory variation causes significant changes in transvalvular inflow velocities, which are exaggerated when tamponade is present...

OBJECTIVE: We aim to evaluate if point-of-care ultrasound use in cardiac arrest is associated with CPR pause duration. METHODS: This is a prospective cohort study of patients with cardiac arrest (CA) presenting to an urban emergency department from July 2016 to January 2017. We collected video recordings of patients with CA in designated code rooms with video recording equipment. The CAs recordings were reviewed and coded by two abstractors. The primary outcome was the difference CPR pause duration when POCUS was and was not performed...

INTRODUCTION: Cardiac arrest management primarily focuses on optimal chest compressions and early defibrillation for shockable cardiac rhythms. Non-shockable rhythms such as pulseless electrical activity (PEA) and asystole present challenges in management. Point-of-care ultrasound (POCUS) in cardiac arrest is promising. OBJECTIVES: This review provides a focused assessment of POCUS in cardiac arrest, with an overview of transthoracic (TTE) and transesophageal echocardiogram (TEE), uses in arrest, and literature support...

BACKGROUND: The prognosis of pulseless electrical activity is dismal. However, it is still challengable to decide when to terminate or continue resuscitation efforts. The aim of this study was to determine whether the use of bedside ultrasound (US) could predict the restoration of spontaneous circulation (ROSC) in patients with pulseless electrical activity (PEA) through the identification of cardiac activity. METHODS: This was a systematic review and meta-analysis of studies that used US to predict ROSC...

BACKGROUND: Acute dyspnea is one of the main reasons for admission to Emergency Department (ED). Availability of ultraminiaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. The aim of this study was to identify an integrated ultrasound approach for diagnosis of acute heart failure (acute HF), using PUD and combining evaluation from lung, heart and inferior vena cava (IVC). METHODS: We included 102 patients presenting to the ED of "Antonio Cardarelli" Hospital in Naples (Italy) for acute dyspnea (AD)...

STUDY OBJECTIVE: We determine the diagnostic accuracy of goal-directed echocardiography, cardiac biomarkers, and computed tomography (CT) in early identification of severe right ventricular dysfunction in normotensive emergency department patients with pulmonary embolism compared with comprehensive echocardiography. METHODS: This was a prospective observational study of consecutive normotensive patients with confirmed pulmonary embolism. Investigators, blinded to clot burden and biomarkers, performed qualitative goal-directed echocardiography for right ventricular dysfunction: right ventricular enlargement (diameter greater than or equal to that of the left ventricle), severe right ventricular systolic dysfunction, and septal bowing...

Differentiation of normal from abnormal findings is critical in echocardiography. Anatomic variants occurring in normal cardiac developments often simulate pathologic entities. This review focuses on the differential diagnosis of normal anatomic structures from pathologic ones in echocardiography.

INTRODUCTION: This study evaluates the agreement between emergency physician (EP) assessment of diastolic dysfunction (DD) by a simplified approach using average peak mitral excursion velocity (e'A ) and an independent cardiologist's diagnosis of DD by estimating left atrial (LA) pressure using American Society of Echocardiography (ASE) guidelines. METHODS: This was a secondary analysis of 48 limited bedside echocardiograms (LBE) performed as a part of a research study of patients presenting to the Emergency Department (ED) with elevated blood pressure but without decompensated heart failure...

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