In training emergency physicians the carotid artery Doppler with passive leg raise, does previous sonographic experience influence scan time and competency?. Issue 1 (16th April 2020)

• Record Type: Journal Article
• Authors: Osgood, Robert; Mohan, Sangeeth; John, Lisa; Stirling, Erin; Stirling, Scott
• Is Part Of: Australasian journal of ultrasound in medicine. Volume 24:Issue 1(2021)
• Page Start: 20
• Page End: 26
• Publication Date: 2020-04-16
• Subjects: carotid VTi -- emergency medicine training -- fluid responsiveness -- fluid resuscitation -- haemodynamics -- POCUS -- shock -- ultrasonography; Ultrasonics in medicine -- Periodicals; Ultrasonic imaging -- Periodicals; Ultrasonic imaging; Ultrasonics in medicine; Periodicals; 616.075430
• DOI: 10.1002/ajum.12204
• Languages: English
• ISSNs: 1836-6864

Abstract

Abstract: Background: Determination of fluid responsiveness (FR) associated with intravascular fluid resuscitation in hypotensive patients poses a challenge, with current best evidence methods fraught with poor retest reliability and difficulty in image acquisition (Osman, Crit Care Med 2007; 35: 64; Marik, Crit Care Med 2009; 37: 2642). Doppler carotid blood flow with passive leg raise (PLR) is a recent modality for determining FR (Marik, Chest 2013; 143: 364). Purpose: This study aimed to determine whether emergency physicians with limited ultrasound experience can reliably acquire this skill. Method: This prospective study recruited 60 emergency physicians with varying experience, who underwent a 3‐step learning programme. Participants performed carotid velocity time integral (VTi) Doppler on healthy subjects, followed by repeat measurements in the PLR position. A 16‐point checklist and time recorded were assessed for each sonographer, with each participant completing a post‐study questionnaire to evaluate perceived competence and ease of skill acquisition. Results: Of the 60 emergency physicians recruited, 37 (61.6%) were inexperienced and 23 (38.4%) were experienced. Against the 16‐point assessment, 61% completed assessment without any errors. Fifty‐six out of 60 (94.3%) completed the assessment to acceptable standard with errors recognised and corrected, and four participants (6.7%) made critical errors without correction (Figure 1). Average (±SEM) total scan time was 4:52 ± 0:19, with no significant difference found between inexperienced and experienced groups. Conclusions: This study demonstrated feasibility to train emergency physicians, demonstrating that average FR assessment was obtained within 5 min, with no difference between prior experience in scan quality/time taken. 94% completed the scan to acceptable standards, demonstrating ease of carotid Doppler flow with PLR to provide critical information in management of the hypotensive patient.