Introduction
Materials and methods
Protocol registration and search strategy
Selection process and data collection
Risk of bias and quality assessment
Statistical analysis
Results
Search and study selection
Source | Study design (RCT /OBS) | Sample size (% male) | Examiner experience with PoCUSa | Examination protocol | Eligibility criteriab,c | Outcomes | |
---|---|---|---|---|---|---|---|
PoCUS protocol | Control | ||||||
Baker [40] | RCT | 442 (58) | Mixed | Volpicelli’s 8 view, subcostal cardiac clip (posterior lung not tested) | Medical history, physical examination, ECG, blood test, CXR, echocardiography, CT | Inc: ≥ 60 years, able to understand and sign a written consent, not requiring immediate resuscitation Exc: no data | Length of stay, mortality |
Blans [46] | OBS | 61d (52) | Beginner | BLUE, cardiac: standard transthoracic windows: LV/RV dilatation and function, pericardial tamponade / effusion, subcostal view: IVC | Not stated | Inc: call for MET based on Modified Early Warning Score Exc: pregnancy, requiring direct lifesaving intervention, GCS < 9 or GCS declined ≥ 2 as the primary reason for MET attendance | Mortality |
Colclough [38] | RCT | 40 (55) | Not specified | Cardiac (based on Preoperative Pocket Echocardiography Trial) | Not stated | Inc: National Health Service triage category 1–3 Exc: no data | Time to diagnosis, mortality |
Corsini [47] | OBS | 124 (61) | Beginner | Bilateral anterior, Lateral, and posterior lung ultrasound, transabdominal scanning for lung bases and subcostal for diaphragm | CXR | Inc: ≥ 23 week of gestational age, RR > 60, oxygen supplementation, respiratory support Exc: CPR | Time to diagnosis |
Harel [48] | OBS | 202 (61) | Not specified | no data | CXR | Inc: < 18 years, suspected pneumonia Exc: ED left before discharge, both PoCUS and CXR were made, PoCUS undertaken not by patient’s treating physician | Length of stay, re-admission rate |
Laursen [39] | RCT | 315 (43) | Expert | FATE protocol, modified Volpicelli’s 8 view, deep veins according to American College of Emergency Medicine’s criteria | Blood samples, blood gasses, ECG, CXR, CT, echocardiography | Inc: RR > 20, SAT < 95%, coughing, chest pain Exc: permanent mental disability, PoCUS not done within 1 h after the primary assessment | Length of stay, re-admission rate, mortality |
Nakao [45] | OBS | 324 (49) | Not specified | Volpicelli’s 8 view | Not stated | Inc: ≥ 50 years, suspected acute heart failure or COPD exacerbation Exc: ST-elevation myocardial infarction, known interstitial fibrosis, lobectomy or PTX | Time to treatment, length of stay |
Pivetta [41] | RCT | 518 (53) | Not specified | Volpicelli’s 8 view | Past medical history, history of present illness, physical examination, arterial blood gas analysis, ECG, CXR, N-terminal pro-brain natriuretic peptide | Inc: sudden onset of dyspnea or increase in the severity of chronic dyspnea in the previous 48 h Exc: mechanically ventilated at the time of first evaluation, dyspnea in context of trauma | Time to diagnosis, length of stay, mortality |
Riishede [42] | RCT | 211 (51) | Expert | Volpicelli’s 8 view (modified), subcostal or apical cardiac (4-chamber: pericardial effusion, LV function, RV overload) | clinical examination, blood samples, ECG, CXR, CT, echocardiography | Inc: coughing, chest pain, RR > 20, SAT < 95% Exc: PoCUS already done, inability to randomize or do PoCUS < 4 h | Appropriate treatment, re-admission rate, mortality |
Seyedhosseini [43] | RCT | 50 (58) | Mixed | BLUE protocol | Patients’ history, physical examination, CXR, biochemistry, CT | Inc: > 12 years, Acute Respiratory Distress Syndrome within the past 7 days Exc: dyspnea due to previously diagnosed medical condition, need CPR on arrival | Time to treatment, length of stay, mortality |
Wang [44] | RCT | 128 (51) | Expert | BLUE protocol, parasternal long-axis view to assess cardiac contractility and left ventricular ejection fraction, subxiphoid view to assess IVC | Bedside CXR, central venous and arterial blood gas parameters, myocardial injury marker levels, pulse index contour continuous cardiac output catheter, pulmonary artery catheter | Inc: admitted to ICU with acute pulmonary edema, dyspnea in 48 h, partial arterial oxygen pressure / fraction of inspired oxygen < 300 mmHg, bedside CXR showing ≥ 1 new sign of acute pulmonary edema according to the assessment of the attending ICU physician Exc: history of chronic cardiac dysfunction | Time to diagnosis, length of stay, mortality |
Wang [51] | RCT | 130 (49) | Expert | Extended FATE and BLUE-plus protocols were modified into a critical care ultrasonic examination protocol | Vital signs, medical history, physical examination, laboratory tests, CXR, CT | Inc: required emergent critical consultation for pulmonary or circulation failures from medical / surgical units, post-surgical patients Exc: refused ICU transfer, already experienced cardiac arrest, advanced cancer | Time to diagnosis, time to treatment, mortality |
Zanobetti [49] | OBS | 2683 (51) | Expert | LUS (longitudinal and oblique scans on anterolateral and posterior thoracic areas, according to Volpicelli), cardiac (apical 4-chamber view to evaluate left ventricular ejection fraction or presence of right ventricular dilatation, subcostal long axis to assess pericardial effusion and left ventricular ejection fraction), IVC | Vital signs, medical history, physical examination, ECG, CXR, CT, echocardiography, blood sampling or arterial blood gas | Inc: acute dyspnea of every degree Exc: traumatic origin, discharged after ED evaluation | Time to diagnosis |
Zieleskiewicz [50] | OBS | 165 (62) | Mixed | Cardiac (left and right ventricular function, pulmonary assessment), BLUE protocol, imaging of the deep veins when deemed necessary | Taking medical history, performance of a circulatory, respiratory and neurological assessment, vital signs, blood testing, conduction of any additional tests judged necessary by the physician | Inc: medical or surgical wards and developing respiratory and/or circulatory failure justifying placement of a call to the RRT Exc: pregnancy, cardiac arrest, technical limitations to the performance of US, lung or cardiac transplant, RRT call for a neurological failure, RRT call by the ED and impossible follow-up | Time to diagnosis, time to treatment, length of stay, appropriate treatment, mortality |