Point-of-care ultrasound in the management of shock: A pilot observational prospective study
Quality Improvement & Outcomes
Our project allowed us to understand POCUS workflows and patterns across institutions to inform important Knowledge Translation initiatives and pave way for a national randomized control trial study. Additionally, this project has helped build a critical research infrastructure for the conduct of POCUS research in the critically ill. We leveraged this infrastructure to inform the design of an international, observational sub-study across 52 sites and 10 countries.
We conducted phase 1 of our project which was a pilot observational study to inform the feasibility of a future multicenter observational study and to address key knowledge gaps and describe POCUS practice patterns in order to inform the design of high-quality RCTs.
Methodology: Patients were screened and recruited in two ICU-hospitals in London, Ontario. Patients were eligible if they were over the age of 18, had a suspicion of shock based on clinical signs (lactate > 2.1, on vasoactive medications), and enrolled within 12 hours of ICU admission.
Results: We recruited 100 patients with a rate of 3 patients per week (target: 2 per week). Consent rate for eligible patients was 100% (95% CI 95 to 100) with CRF completions rates at 97% (95% CI 93 to 100). In our study, 70% of patients received POCUS to guide the resuscitation of shock. POCUS practitioners typically performed 2 cardiac and 1 lung scan in the first 5 days of ICU admission. More than 80% (63 number of scans) of cardiac scans included quantitative echocardiographic measurements. We found no differences in, ICU death, ICU length of stay, days on vasoactive medication, or mechanical ventilation days.
Conclusion: Based on our recruitment rate, consent rate, and CRF completion rates, conducting a national, multicenter observational study is feasible. This successful pilot study marks the completion of the first phase of a program of research that will address knowledge gaps across the nation and inform the design of high quality RCTs evaluating the impact of POCUS guided resuscitation on patients with shock.
Next Steps: This pilot study has shown that a national, multicenter observational study (phase 2 and 3) is feasible and next we will address key knowledge gaps and lay the foundation for well-designed randomized controlled trials (RCT) evaluating the impact of POCUS guided resuscitation on clinical outcomes in patients with shock (phase 4).
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