Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study

• Published in: PloS one Vol. 8; no. 6; p. e66951
• Main Authors: Zorko, David J, Choong, Karen, Gilleland, Jonathan, Agar, Barbara, Baker, Shawn, Brennan, Cindy, Pullenayegum, Eleanor
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.06.2013; Public Library of Science (PLoS)
• Subjects: Assessments; Cardiac output; Cardiac patients; Cardiovascular equipment; Child, Preschool; Children; Consultation; Critical care; Defects; Emergency medical care; Emergency medical services; Emergency Medical Services - methods; Emergency vehicles; Epidemiology; Feasibility studies; Health sciences; Heart; Heart diseases; Hemodynamics; Hospital patients; Humans; Intensive care; Male; Medicine; Patients; Pediatrics; Physicians; Physiology; Pilot Projects; Pulmonary arteries; Quality; Resuscitation; Sepsis; Studies; Time Factors; Transport; Ultrasonics; Ultrasound; Ontario Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0066951

To determine the feasibility of using the Ultrasound Cardiac Output Monitor (USCOM) as an adjunct during hemodynamic assessments by a pediatric medical emergency team (PMET). Pediatric in-patients at McMaster Children's Hospital aged under 18 years requiring urgent PMET consultation, were eligible. Patients with known cardiac outflow valve defects, Pediatric Critical Care Unit in-patients, and those in cardiorespiratory arrest, were excluded. The primary outcome was feasibility, and the ease of USCOM transport and application as assessed by a self-administered user questionnaire. Secondary outcomes included the quality of USCOM measurements, and agreement in clinical versus USCOM-derived assessments. Forty-one patients from 85 eligible PMET consultations were enrolled between March and August 2011. A total of 55 USCOM assessments were performed on 36 of 41 (87.8%) participants. USCOM could not be completed in 5 (12.2%) participants due to patient agitation (n = 4) and emergent care (n = 1). USCOM was reported as easy to transport and apply by 97.4% and 94.7% of respondents respectively, not obstructive to patient care by 94.7%, and yielded timely measurements by 84.2% respondents. USCOM tracings were of good quality in 41 (75.9%) assessments. Agreement between clinical and USCOM-derived hemodynamic assessments by two independent raters was poor (Rater 1: κ = 0.094; Rater 2: κ = 0.146). USCOM can be applied by a PMET during urgent hemodynamic assessments in children. While USCOM has been validated in stable children, its role in guiding hemodynamic resuscitation and informing therapeutic goals in a hemodynamically unstable pediatric population requires further investigation.