Page 180 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 8
Discussion
The main finding of the study is that in 88% of patients ultrasound guided resuscitation influenced or supported treatment and other decisions. Most frequently reported were ter- mination or continuation of resuscitation and increasing the infusion of IV fluids. This could be expected because prehospital ultrasound may yield information about conditions that are difficult to diagnose by other means during ongoing CPR. These findings suggest that ultrasound can be useful in guiding prehospital CPR management.
This study confirms the findings of previous studies that have shown that ultrasound can lead to treatment changes. Recently, O’Dochartaigh reported that 25% and 45% of prehospi- tal ultrasound scans supported interventions in trauma and medical patients, respectively.11 The type of ultrasound findings and interventions reported in our study were similar. Bre- itkreutz showed altered management in 66% of patients subjected to prehospital peri-resus- citation ultrasound and in 89% of patients undergoing CPR.6 Shokoohi showed changes in management on the ED in undifferentiated hypotension varying between 11.9% and 30.5% for changes in treatment, diagnostic imaging, consultation and admission location.12 Our observations have added new insight into the role of ultrasound in the specific prehospital population that is being resuscitated by ground ambulance personnel supported by HEMS physicians and nurses.
Strengths and limitations
The strength of this study is the specific setting in which it has been conducted which con- tributes to its originality. These findings might be applied to the more homogeneous team settings across European HEMS. Conversely, it may be difficult to apply these findings to non-physician-staffed HEMS, such as most U.S. services.
Carrying out a prospective study in a physician-staffed helicopter emergency medical ser- vice, especially in a CPR scenario, is challenging. Many external factors will influence the mixed team of health care workers and the patient and its environment. Working space and resources are often limited, time pressure is high, and personnel perceive pressure to perform. Furthermore, they are working in surroundings and with colleagues they are often unfamiliar with.
The design and specific setting of the study introduce several limitations. We performed echocardiography only in a limited number of cardiac arrest patients. An explanation could be that in our prehospital setting, with a considerable proportion of trauma victims, the