None listed
Conditions
Brief summary
Current cardiac arrest algorithms require assessment of the return of spontaneous circulation (ROSC) following rhythm checks by observation for patient movement or spontaneous respirations, both of which may be absent in sedated and paralysed patients. Healthcare professionals may also check for a pulse in the presence of an organized rhythm, however manual pulse checks have been demonstrated to be unreliable, even when performed by health professionals. There have been two papers published from St George Hospital (Sydney) related to the use of ultrasound (US) of central pulses and whether they may be an alternative to manual pulse checks. The first was a case report where US of the femoral artery demonstrated ROSC and guided subsequent resuscitation, following cardiac arrest in a patient where manual pulses were absent. The second was an investigation into the inter-rater reliability of carotid US in detecting the return of a pulse, using cardiac surgery patients coming off bypass (where they go from no-pulse to a pulse). This showed a high intraclass correlation (0.86) for two-dimension (2D) ultrasound when detecting the return of a pulse. This current study seeks to extend on these previous efforts by assessing the validity of carotid US in detecting the presence/absence of a pulse. We hope to use cardiac surgery patients as a human model for the presence and absence of a pulse by obtaining 2D US of the carotid arteries when not on bypass (when there is a pulse), and on bypass (when a pulse is not present). We will then present these videos to critical care physicians who are familiar with US and would be likely to perform an US in a cardiac arrest. We will assess the validity using diagnostic test criteria for subgroups of MAP, and the cohort as a whole. Our gold standard will be presence or absence of a pulsatile waveform on the participants radial artery pressure monitoring.
Interventions
Ten-second two-dimension ultrasound videos of the carotid artery at mean arterial pressure of 20-30mmHg, 40-50mmHg, 60-70 mmHg during cardiac surgery off bypass to be reviewed by critical care resident doctor
Sponsors
St George Hospital, Kogarah
Study design
Allocation
Randomised controlled trial
Intervention model
Single group
Primary purpose
Diagnosis
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
There will be two groups of participants: 1. Carotid ultrasound participants. These participants will be from consenting cardiac surgery volunteers. All cardiac surgery patients who will be placed on bypass during their surgery, including valve replacement or coronary artery bypass grafts. Age > 18. Ability to offer informed consent. 2. Critical care physician readers. These participants will be consenting volunteer critical care physicians who will be asked to review a maximum of 30 of the carotid ultrasound video clips. Any post-graduate critical care physician who uses ultrasound in their clinical practice, whether for focussed echocardiography, central line placement or trauma assessment.
Exclusion criteria
Cardiac surgery participants: Previous surgery involving the great blood vessels including aorta or carotid arteries. Patients who the cardiac surgeon considers to be inappropriate due to a high surgical risk, patients with an intra-aortic balloon pump, and patients with known carotid artery stenosis. Critical care physician readers: No previous experience with ultrasound.
Outcome results
None listed