Urgent Ultrasound Guided Hemodynamic Assessments by a Pediatric Medical Emergency Team: A Pilot Study

<div><p>Purpose</p><p>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).</p><p>Methods</p><p>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.</p><p>Results</p><p>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).</p><p>Conclusion</p><p>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.</p></div

Baseline Characteristics.

<p>PMET indicates pediatric medical emergency team.</p>a<p>Data presented as mean (SD) unless otherwise specified.</p>b<p>Indicates tachypnea, increased work of breathing, or hypoxemia.</p>c<p>Indicates tachycardia, hypotension, or hypoperfusion.</p>d<p>Indicates change in neurological status, decreased level of consciousness, or seizures.</p>e<p>Other reasons for PMET consultation include lactic acidosis and hyperglycemia.</p>f<p>Other admission diagnoses include multiple anomalies, apparent life-threatening event, trauma, sickle cell crisis, and dehydration.</p

Outcomes of Interest.

<p>USCOM indicates Ultrasound Cardiac Output Monitor; PMET, pediatric medical emergency team; MD, physician; RRT, registered respiratory therapist; PI, principal investigator; RN, registered nurse.</p>a<p>Data presented as median (min,max) unless otherwise specified.</p>b<p>Indicates elapsed time between PMET consultation and PMET arrival.</p>c<p>Indicates elapsed time between PMET arrival and start of USCOM assessment.</p>d<p>7-Point Likert Scale.</p>e<p>Maximum score of 12. Scores ≥8 points denotes a good quality tracing, <8 points denotes a poor quality tracing <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0066951#pone.0066951-OnTang1" target="_blank">[22]</a>.</p

Enrolment and outcomes. USCOM indicates Ultrasound Cardiac Output Monitor; PMET, pediatric medical emergency team.

<p><i>^a</i>Missed patients indicates research personnel were available, but patient was not screened.</p