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Variability in Interpretation of Cardiac Standstill Among Physician Sonographers
Kevin Hu1, Nachi Gupta1, Felipe Teran1
1Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Insights
Physician sonographers showed significant variability in interpreting cardiac standstill on point-of-care ultrasound during cardiac arrest. Standardized definitions are needed to improve research and bedside application of this prognostic tool.
Area of Science:
- Emergency Medicine
- Critical Care
- Cardiology
- Point-of-Care Ultrasound
Background:
- Cardiac standstill on point-of-care ultrasound is a studied prognostic marker in cardiac arrest.
- Existing research shows wide variation in reported return of spontaneous circulation (0-45%).
- Definitions of cardiac activity in studies are inconsistent, ranging from minor echogenicity changes to kinetic activity.
Purpose of the Study:
- To assess the variability in the interpretation of cardiac standstill among physician sonographers.
- To investigate how inconsistent definitions of cardiac activity impact the interpretation of cardiac arrest ultrasound videos.
Main Methods:
- A survey was conducted among physician sonographers at 6 conferences.
- Participants reviewed 15 video clips of patients in cardiac arrest, with 20 seconds per clip to determine standstill.
- Data were collected anonymously from 127 faculty, fellows, and residents across emergency medicine, critical care, and cardiology.
Main Results:
- Moderate interrater agreement (α=0.47) was observed among all participants.
- This lack of agreement was consistent across different medical specialties, training levels, and self-reported expertise.
- Significant variability exists in how physician sonographers interpret cardiac standstill.
Conclusions:
- Considerable variability in the interpretation of cardiac standstill among physician sonographers was found.
- Developing consensus definitions for cardiac activity and standstill is crucial.
- Standardized definitions will enhance the quality of cardiac arrest ultrasound research and bedside use.
Study Objective:
Cardiac standstill on point-of-care ultrasonography has been widely studied as a marker of prognosis in cardiac arrest. Return of spontaneous circulation has been reported in as few as 0% and as many as 45% of patients with cardiac standstill. When explicitly documented, the definition of cardiac activity in these studies varied from any slight change in echogenicity of the myocardium to any kinetic cardiac activity. We hypothesize that the variability in research definitions of cardiac activity may affect interpretation of video clips of patients in cardiac arrest. The goal of this study is to assess the variability in interpretation of standstill among physician sonographers.
Methods:
We surveyed physician sonographers at 6 conferences held at 3 academic medical centers in the Greater New York area. Survey respondents were allotted 20 seconds per slide to determine whether each of 15 video clips of patients in cardiac arrest were standstill or not. Data were collected anonymously with radio frequency remotes.
Results:
There were 127 total participants, including faculty, fellows, and resident physicians specializing in emergency medicine, critical care, and cardiology. There was only moderate interrater agreement among all participants (α=0.47). This lack of agreement persisted across specialties, self-reported training levels, and self-reported ultrasonographic expertise.
Conclusion:
According to the results of our study, there appears to be considerable variability in interpretation of cardiac standstill among physician sonographers. Consensus definitions of cardiac activity and standstill would improve the quality of cardiac arrest ultrasonographic research and standardize the use of this technology at the bedside.
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