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POCUS in Out-of-Hospital Cardiac Arrest

Published online by Cambridge University Press:  05 April 2022

Mustafa Emin Canakci Open the ORCID record for Mustafa Emin Canakci [Opens in a new window] ,
Engin Ozakin Open the ORCID record for Engin Ozakin [Opens in a new window]  and
Nurdan Acar
Mustafa Emin Canakci*
Affiliation:
Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
Engin Ozakin
Affiliation:
Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
Nurdan Acar
Affiliation:
Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
*
Correspondence: Mustafa Emin Canakci, MD Emergency Department Eskisehir Osmangazi University School of Medicine Prof. Dr. Nabi Avcı Boulevard No:4, Meselik, Odunpazarı, 26040 Eskisehir, Turkey E-mail: mustafaeminc@gmail.com
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Abstract

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Keywords

cardiac arrestPOCUSprehospital
Type
Letter to the Editor
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 3 , June 2022 , pp. 423
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

To the Editor:

We have read with great interest the recent article “Point-of-Care Ultrasound Use by EMS Providers in Out-of-Hospital Cardiac Arrest” by Kreiser, et al. Reference Kreiser, Hill and Karki1 This article is invaluable as it evaluates the prehospital point-of-care ultrasound (POCUS) practice, which is rarely used world-wide in Emergency Medical Services (EMS), and the ability of paramedics to use ultrasound. Reference Kreiser, Hill and Karki1 As the authors stated, since healthy information cannot be obtained with pulse control, real-time evaluation with ultrasonography will both accelerate the diagnosis process and reduce the number of wrong applications.

First of all, we would like to state that the methodology of the study was very well-established. Thanks to the detailed creation of the Prehospital Echocardiogram in Cardiac Arrest (PECA) protocol, it will lead to future randomized studies.

There are some points about the study that we would like to discuss. The first of these concerns the groups that were not included in the study. We could not clearly understand the reason for exclusion of patients with electrocution and witnessed drowning.

Survival to admission rates were 21.1%, while survival to discharge rates were 2.6%. Survival to discharge rates are lower than previous studies. Reference Yan, Gan and Jiang2,Reference Chan, Girotra, Tang, Al-Araji, Nallamothu and McNally3 Of course, this may vary according to patient characteristics. However, this situation arouses curiosity since no information is given about patient characteristics. Although it is stated that the evaluation takes less than 10 seconds, we think that the information on how many seconds the evaluation is made on mean or median should be given. It could also give an idea about the success of the intervention if it was compared with the standard care group in addition to the POCUS group evaluated in the study.

In addition, we think that paramedics will be successful in applying prehospital ultrasound to the correct place of cardiac compressions. Reference Zanatta, Lorenzi, Scorpiniti, Cianci, Pasini and Barchitta4 Although not mentioned in the study, there is no doubt that EMS personnel will increase survival with appropriate compressions.

We think that this study is very valuable in terms of demonstrating the skills of the prehospital staff. We are sure that POCUS applications will become more wide-spread in the future. We thank the authors for writing this important article.

Conflicts of interest

The authors declare none.

References

Kreiser, MA, Hill, B, Karki, D, et al. Point-of-care ultrasound use by EMS providers in out-of-hospital cardiac arrest. Prehosp Disaster Med. 2022;37(1):39–44.10.1017/S1049023X21001357CrossRefGoogle ScholarPubMed
Yan, S, Gan, Y, Jiang, N, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020;24(1):61.10.1186/s13054-020-2773-2CrossRefGoogle ScholarPubMed
Chan, PS, Girotra, S, Tang, Y, Al-Araji, R, Nallamothu, BK, McNally, B. Outcomes for out-of-hospital cardiac arrest in the United States during the coronavirus disease 2019 pandemic. JAMA Cardiol. 2021;6(3):296–303.10.1001/jamacardio.2020.6210CrossRefGoogle ScholarPubMed
Zanatta, M, Lorenzi, C, Scorpiniti, M, Cianci, V, Pasini, R, Barchitta, A. Ultrasound-guided chest compressions in out-of-hospital cardiac arrests. J Emerg Med. 2020;59(6):e225–e233.10.1016/j.jemermed.2020.07.005CrossRefGoogle ScholarPubMed