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LO44: Initial validation of the core components in the SHoC-Hypotension Protocol. What rates of ultrasound findings are reported in emergency department patients with undifferentiated hypotension? Results from the first Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHOC-ED1) Study; an international randomized controlled trial

Published online by Cambridge University Press:  15 May 2017

D. Lussier*
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
C. Pham
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
J. Milne
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
D. Lewis
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
L. Diegelmann
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
H. Lamprecht
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
R. Henneberry
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
J. Fraser
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
M. Stander
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
D.J. van Hoving
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
D. Fredericks
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
M. Howlett
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
J. Mekwan
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
B. Ramrattan
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
J. Middleton
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
P. Olszynski
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
M. Peach
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
L. Taylor
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
T. Dahn
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
S.T. Hurley
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
K. MacSween
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
C. Cox
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
S. Hunter
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
J. Bowra
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
M. Lambert
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
R. Jarman
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
T. Harris
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
V. Noble
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
J. Connolly
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
P.R. Atkinson
Affiliation:
Department of Emergency Medicine, University of Manitoba, Health Sciences Centre, Saint John, NB
*
*Corresponding authors

Abstract

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Introduction: Point of care ultrasound (PoCUS) has become an established tool in the initial management of patients with undifferentiated hypotension in the emergency department (ED). Current established protocols (e.g. RUSH and ACES) were developed by expert user opinion, rather than objective, prospective data. Recently the SHoC Protocol was published, recommending 3 core scans; cardiac, lung, and IVC; plus other scans when indicated clinically. We report the abnormal ultrasound findings from our international multicenter randomized controlled trial, to assess if the recommended 3 core SHoC protocol scans were chosen appropriately for this population. Methods: Recruitment occurred at seven centres in North America (4) and South Africa (3). Screening at triage identified patients (SBP<100 or shock index>1) who were randomized to PoCUS or control (standard care with no PoCUS) groups. All scans were performed by PoCUS-trained physicians within one hour of arrival in the ED. Demographics, clinical details and study findings were collected prospectively. A threshold incidence for positive findings of 10% was established as significant for the purposes of assessing the appropriateness of the core recommendations. Results: 138 patients had a PoCUS screen completed. All patients had cardiac, lung, IVC, aorta, abdominal, and pelvic scans. Reported abnormal findings included hyperdynamic LV function (59; 43%); small collapsing IVC (46; 33%); pericardial effusion (24; 17%); pleural fluid (19; 14%); hypodynamic LV function (15; 11%); large poorly collapsing IVC (13; 9%); peritoneal fluid (13; 9%); and aortic aneurysm (5; 4%). Conclusion: The 3 core SHoC Protocol recommendations included appropriate scans to detect all pathologies recorded at a rate of greater than 10 percent. The 3 most frequent findings were cardiac and IVC abnormalities, followed by lung. It is noted that peritoneal fluid was seen at a rate of 9%. Aortic aneurysms were rare. This data from the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients, supports the use of the prioritized SHoC protocol, though a larger study is required to confirm these findings.

Type
Oral Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2017