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Handheld Ultrasound Trends.

Prehospital Ultrasound in Emergency Medicine: Think Outside the 4 Walls

In cardiac care, mere minutes matter. That's why some medical specialists today may be turning to prehospital ultrasound to accelerate treatment, ensuring patients receive life-saving therapies faster.

In the hands of paramedics and other emergency services providers, handheld ultrasound devices, such as GE's Vscan Extend™, may obtain cardiac images sufficient enough for interpretation even before patients arrive in the emergency department. With proper training, prehospital clinicians can not only use ultrasound to identify a problem, but also to help triage patients.

Benefits of Prehospital Use
Point-of-care ultrasound (PoCUS) has already been shown to potentially help diagnose a plethora of life-threatening conditions, such as hemoperitoneum, pericardial effusion, cardiac tamponade, pneumothorax and abdominal aortic aneurysm. Prehospital ultrasound can also identify situations where resuscitative efforts could be beneficial and should be continued. Putting those diagnostic capabilities to use en route to a hospital may save more lives.

For example, according to investigators in a World Journal of Emergency Medicine study, PoCUS education for paramedics can be helpful to patients: "Our pilot study suggests that with minimal training, paramedics can use [ultrasound] to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill."

An American Journal of Emergency Medicine editorial also discussed the importance of using prehospital ultrasound in situations with critical patients.

"Streamlined [focused assessment with sonography for trauma] may increase triage accuracy of blunt torso trauma patients in mass casualty incidents with limited medical resources," the authors noted. "We recommend the use of [streamlined focused assessment with sonography for trauma] to decrease patient triage to treatment time in any unfortunate future disasters."

In many instances, prehospital clinicians are the first to interact with critically ill patients. Consequently, having PoCUS available to provide real-time internal images may provide significant benefits to both cardiac life support and advance trauma support. Not only may it assist with any prehospital decision-making, but it may also help inform how physicians proceed once patients arrive in the emergency department.

Real-World Implementation
Prehospital ultrasound offers a real-world option in helping to provide immediate care to patients in acute situations. Using GE Vscan Extend™, a helicopter paramedic unit in New Zealand screened airlifted patients for potential cardiac problems prior to landing at Dunedin Hospital, which is located in an area where road travel can be precarious.

In these and other frenetic conditions, PoCUS is helpful because paramedics may clearly see heart function. With ultrasound, New Zealand's paramedics assessed cardiac activity and checked for internal bleeding, thoracic injuries and pulmonary embolisms. They also used handheld ultrasound to side-step unnecessary procedures. For example, PoCUS use determined a suspected pneumothorax in one patient did not exist, so paramedics opted not to decompress the chest.

Prehospital ultrasound may also be used to triage patients who should be taken immediately to the operating room. Doing so saves valuable time otherwise spent running further diagnostic tests in the emergency department.

PoCUS Training
Handheld ultrasound can be a valuable tool for nearly any healthcare provider who receives proper training. Paramedics and other prehospital clinicians may achieve the same level of skill as physician sonographers if they undergo comparable instruction.

This level of accuracy may alter and positively impact the care a patient receives upon arriving at the hospital by giving physicians insight into a patient's condition.

While research into the use of prehospital ultrasound is in the early phases, study results and real-world implementation have already shown it may play a vital role in time-sensitive, critical conditions. All in all, proper use may decrease both mortality and morbidity, improving overall patient outcomes.
 

The device has been verified for limited use outside of professional healthcare facilities including during transport. Use is restricted to environmental properties described in the user manual , please contact your GE Healthcare sales representative for detailed information

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Handheld Ultrasound Education.

How Handheld Cardiac Ultrasound Aids in Diagnosis

Handheld cardiac ultrasound does not aim to replace routine comprehensive echocardiography, but its use may decrease the frequency of comprehensive scans. As a result, it might not only make clinicians' lives easier, but it may also lead to better patient experiences and outcomes.

Making a Cardiology Diagnosis
There are many applications for handheld ultrasound in making a cardiology diagnosis. For example, it may be used specifically to assess cardiac chamber size and function and valvular regurgitation. An article in Clinical Cardiology reported that "the pocket-sized [portable transthoracic echo (pTTE)] provides accurate detection of cardiac structural and functional abnormalities beyond the [electrocardiogram (ECG)]. In addition, the use of pTTE as an initial screening tool prior to [standard TTE] is cost-effective, suggesting that the pocket-sized pTTE is poised to alter the current diagnostic strategy in clinical practice."

Non-cardiologists may use handheld ultrasound as a tool for aortic stenosis and mitral regurgitation. This means that the ultrasound may be an adjunct to clinical examination in patients where a murmur is heard. Wiener Klinische Wochenschrift reports, "Pocket-size ultrasound imaging devices without continuous and pulse wave Doppler modalities can, even in the hands of a non-cardiologist with limited cardiac ultrasound instructions with high sensitivity and specificity, be a useful tool for detecting more than mild aortic stenosis and more than mild mitral regurgitation."

Handheld ultrasound may also be used to assess the volume status of the patient, via the inferior vena cava (IVC) diameter, as an indicator of progression of heart failure. As discussed in the American Journal of Cardiology, this use of ultrasound "is associated with an increased risk of heart failure admission and may provide clinically useful information at the point of care to guide heart failure management."

Augmenting Workflow
Handheld ultrasound may be used by primary care physicians to detect cardiovascular disease, and this may decrease the number of unnecessary formal echocardiograms. One study, published in Heart, used remote expert support to help interpret the handheld ultrasound images and found it to be "rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies."

Having repeat formal transthoracic echocardiograms (TTEs) to detect problems such as impaired ventricular function, pericardial effusion and IVC collapse is common. Using handheld, focused ultrasound scans of the heart may reduce the need for so many follow-up TTEs in a short space of time. A paper in the Journal of the American Society of Echocardiography concluded that "[t]he judicious use of expert focused cardiac ultrasound in place of repeat inpatient TTE has the potential to deliver quality cardiac imaging at reduced cost."

In some patients who are acutely unwell, moving them into a good position in their bed for a formal echocardiogram could be challenging. Handheld ultrasound may have an advantage as it can be used on patients in a semi-recumbent position. An article in Acta Anaesthesiologica Scandinavia concluded that "[t]he apparatus is well-suited for performing a [focus-assessed transthoracic echocardiography] examination in a one-day surgery setting and could very well also be applicable in almost any situation involving patients with acute illness."

Streamlining Care
What's more, handheld ultrasound may be used by cardiologists on their ward rounds. Being able to do a bedside ultrasound may reduce the number of formal echo studies that need to be done. As described in the American Journal of Medicine, "For hospitalized patients, [t]his finding could shift the burden of performing and interpreting the echocardiogram to the examining physician and reduce the number and cost associated with formal echocardiography studies."

In emergency departments, handheld ultrasound may reduce the time to diagnosis in patients presenting with shortness of breath. Herz reported, "One-third of patients had significant findings on the scans to possibly aid diagnosis and prevent misdiagnosis. This has the potential to reduce time to diagnosis in the [emergency department]."

Handheld ultrasound may be used by a broad range of healthcare professionals in different specialties to help streamline patient care, improve diagnosis and direct therapy — and it might be a beneficial adjunct to formal echocardiography.
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