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Point-of-care lung and cardiac ultrasound (LUCAS) study in hip fracture patients: a prospective cohort study

Évaluation de l’échographie ciblée pulmonaire et cardiaque au chevet (LUCAS) chez des patient·es avec fracture de hanche : une étude de cohorte prospective

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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

A clinical conflict often presented with hip fracture patients is whether to proceed with timely surgery or delay surgery until a formal echocardiogram is conducted. This study aimed to assess the impact of incorporating point-of-care lung and cardiac ultrasound (LUCAS) scans as part of the preoperative assessment for hip fracture patients.

Methods

We recruited 225 consecutive adult patients booked for urgent hip arthroplasty surgery. A LUCAS scan was performed for each patient. The anesthesiologists were asked to provide their anesthetic plans before and after acknowledging the results of the LUCAS scans. The primary endpoint was a composite outcome of changes to the anesthetic plan. The secondary outcomes included anesthesiologists’ opinions of the LUCAS scans.

Results

One-hundred-ninety-eight patients were included. The majority of LUCAS findings were not severe. A common abnormal finding was hypovolemia (31%). One-hundred-and-six anesthetic management decisions were changed, with 59 of these changes being an escalation of the anesthetic plan, and 47 of these changes being a de-escalation. Eighty-three percent of anesthesiologists agreed that LUCAS affirmed their anesthetic plans and should be an integral part of the perioperative assessment.

Conclusion

This study found that LUCAS scans did not significantly alter the anesthetic plan for hip fracture patients. Nevertheless, LUCAS scans can rule out severe cardiopulmonary conditions and allow for both escalation and de-escalation of care. In the setting of early hip surgery, LUCAS presents a viable option in selected patients to address the unmet need to allow for both timely surgery and comprehensive patient evaluation.

Study registration

ClinicalTrials.gov (NCT03275129); registered 8 July 2018.

Résumé

Objectif

Une interrogation clinique qui existe souvent avec les patient·es se présentant avec une fracture de hanche est de savoir s’il faut procéder à une intervention chirurgicale rapidement ou retarder la chirurgie jusqu’à ce qu’un échocardiogramme formel soit réalisé. Cette étude visait à évaluer l’impact de l’intégration de l’échographie ciblée pulmonaire et cardiaque (LUCAS, Lung and Cardiac ultrasound) dans le cadre de l’évaluation préopératoire des personnes ayant subi une fracture de la hanche.

Méthode

Nous avons recruté 225 patient·es adultes consécutif·ves devant bénéficier d’une arthroplastie urgente de la hanche. Une échographie de type LUCAS a été réalisée pour chaque patient·e. On a demandé aux anesthésiologistes de fournir leurs plans anesthésiques avant et après avoir pris connaissance des résultats des échographies de type LUCAS. Le critère d’évaluation principal était un résultat composite des modifications apportées au plan anesthésique. Les critères d’évaluation secondaires comprenaient les opinions des anesthésiologistes sur les échographies de type LUCAS.

Résultats

Cent quatre-vingt-dix-huit patient·es ont été inclus·es. La majorité des résultats de l’échographie de type LUCAS n’étaient pas graves. Un résultat anormal courant était l’hypovolémie (31 %). Cent six décisions de prise en charge anesthésique ont été modifiées, 59 de ces changements étant une escalade du plan anesthésique et 47 de ces changements étant une réduction. Quatre-vingt-trois pour cent des anesthésiologistes ont convenu que l’échographie de type LUCAS confirmait leurs plans anesthésiques et devrait faire partie intégrante de l’évaluation périopératoire.

Conclusion

Cette étude a révélé que les échographies de type LUCAS ne modifiaient pas de manière significative le plan anesthésique pour les patient·es se présentant avec une fracture de hanche. Néanmoins, les échographies de type LUCAS peuvent exclure des affections cardiopulmonaires graves et permettre à la fois d’augmenter ou de réduire les soins périopératoires. Dans le cadre d’une chirurgie précoce de la hanche, l’échographie de type LUCAS présente une option viable chez une patientèle sélectionnée pour répondre à un besoin non satisfait afin de permettre à la fois une chirurgie rapide et une évaluation complète des patient·es.

Enregistrement de l’étude

www.clinicaltrials.gov (NCT03275129); enregistrée le 8 juillet 2018.

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Author contributions

Jason Chui contributed to study design, grant application, ethics application, patient recruitment, data collection, data analysis, and writing up of the first draft of the paper. Ahmed F. Hegazy, Mark German, and Camila Arango-Ferreira contributed to patient recruitment, data collection, and revision of the paper. Lee-Anne Fochesato contributed to grant application, ethics application, and revision of the paper. Ronit Lavi contributed to study design, grant application, and revision of the paper. Daniel Bainbridge contributed to study design, patient recruitment, data collection, and revision of the paper.

Acknowledgments

This study was supported by the Innovation Fund of the Alternative Funding Plan of the Academic Health Sciences Centres of Ontario. We acknowledge Drs Ronit Lavi and Daniel Bainbridge, who contributed equally to this study.

Disclosures

The authors declare no competing interests.

Funding statement

This study was supported by the Innovation Fund of the Alternative Funding Plan of the Academic Health Sciences Centres of Ontario. The funding sources have no role in study design and conduct, data collection, data analysis, and manuscript writing and submission.

Prior conference presentations

An abstract was submitted to Canadian Anesthesiologists’ Society Annual meeting (24–26 June 2022, Halifax, NS, Canada).

Editorial responsibility

This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Author notes

  1. Ronit Lavi and Daniel Bainbridge have contributed equally as senior authors.

Authors and Affiliations

  1. Department of Anesthesia & Perioperative Medicine, Schulich School Medicine and Dentistry, University of Western Ontario, C3-106, University Hospital, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Jason Chui MBChB, MSc, Ahmed F. Hegazy MD, MSc, MPH, Mark German MD, Camila Arango-Ferreira MD, Lee-Anne Fochesato MSc, Ronit Lavi MD & Daniel Bainbridge MD

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  1. Jason Chui MBChB, MSc
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Correspondence to Jason Chui MBChB, MSc.

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Chui, J., Hegazy, A.F., German, M. et al. Point-of-care lung and cardiac ultrasound (LUCAS) study in hip fracture patients: a prospective cohort study. Can J Anesth/J Can Anesth 70, 1474–1485 (2023). https://doi.org/10.1007/s12630-023-02511-5

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  • DOI: https://doi.org/10.1007/s12630-023-02511-5

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