Barriers to point-of-care ultrasound utilization during cardiac arrest in the emergency department: a regional survey of emergency physicians |
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| Affiliation: | 1. Department of Anaesthesiology, Surgical Intensive Care, Emergency Medicine and Pain Therapy, Klinikum Frankfurt Hoechst, Germany;2. Academic Teaching Hospital of the University of Frankfurt, Germany;1. Center for Resuscitation Science, University of Pennsylvania School of Medicine, University of Pennsylvania Blockley Hall, 423 Guardian Drive, Room 414A, Philadelphia, PA 19104, USA;2. Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA;3. Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA;4. Department of Emergency Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA;5. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA;6. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA;7. Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA;8. Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA;9. Department of Emergency Medicine, School of Medicine University of Arizona Tucson, 1501 N. Campbell Ave, Tucson, AZ 85724, USA;10. Department of Emergency Medicine, University Hospitals, Cleveland Medical Center, Case Western Reserve School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106, USA;11. Department of Emergency Medicine, Christiana Care, 4755 Ogletown Stanton Road, Newark, DE 19718, USA;12. Department of Emergency Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA;13. Department of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y4E9, Canada;14. Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA;15. Division of Cardiology, Department of Internal Medicine, Weil Institute of Emergency and Critical Care, Department of Emergency Medicine, University Virginia Commonwealth University, 1101 E. Marshall Street, Richmond, VA 23298, USA;1. Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK;2. Resuscitation Research Group (RRG), College of Medicine and Veterinary Medicine, University of Edinburgh, The Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK |
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| Abstract: | IntroductionThough point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED).MethodsTwo survey instruments were distributed to emergency medicine (EM) attending and resident physicians at three academic centers in the South Florida. The surveys assessed demographics, experience, proficiency, attitudes and barriers. Descriptive and inferential statistics along with Item Response Theory Logistic Model and the Friedman Test with Wilcoxon Signed Rank tests were used to profile responses and rank barriers.Results206 EM physicians were invited to participate in the survey, and 187 (91%) responded. 59% of attending physicians and 47% of resident physicians reported that POCUS is performed in all their cases of CA. 5% of attending physicians and 0% of resident physicians reported never performing POCUS during CA. The top-ranked departmental barrier for attending physicians was “No structured curriculum to educate physicians on POCUS.” The top-ranked personal barriers were “I do not feel comfortable with my POCUS skills” and “I do not have sufficient time to dedicate to learning POCUS.” The top-ranked barriers for resident physicians were “Time to retrieve and operate the machine” and “Chaotic milieu.”ConclusionsWhile our study demonstrates that most attending and resident physicians utilize POCUS in CA, barriers to high-quality implementation exist. Top attending physician barriers relate to POCUS education, while the top resident physician barriers relate to logistics and the machines. Interventions to overcome these barriers might lead to optimization of POCUS performance during CA in the ED. |
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