Rapid Ultrasonography Before Anesthesia On Prognosis Of Critical Patients Undergoing Emergency Surgery-A Randomized Controlled Study

Background:Clinical bedside ultrasound technique has been used in anesthesia for decades.Not only for nerve block,but also in diagnosis of life threaten pathology such as pneumothorax,heart failure,acute pulmonary edema,hemoperitoneum and so forth.There isn’t a clear answer on whether it helps with the outcome,specifically if any positive findings using ultrasound was treated before anesthesia induction in extremely critical emergency patients.Methods:This prospective,randomized controlled study enrolled 660 patients who requiring emergency surgeries and under general anesthesia in 18medical centers in China.Patients in both groups received traditional evaluation by anesthetist before induction.Patients in ultrasound group received a 10-15 minutes ultrasound scanning including left ventricular function,blood volume,lung and body cavities afterwards by solid scanner who had basic TTE or TOE experiences and got a concentrated train before this clinical trial began.Any positive finding should be told to the responsible anesthetist and gave the proper treatment before induction.The primary outcome was the all-cause mortality in 30 days.Secondary outcomes were ICU administration rate,mortalities in 90 days,half a year,one year,complications,ICU hours,cost and hospital cost.SF-8 health score postoperatively.Results:660 patients from 18 medical centers were randomized to 2 groups:ultrasound group（n=326）and control groups（n=334）.16 patients missing in the first follow-up（7 in ultrasound group and 9 in control group）.50 patients died in ultrasound group and 53 died in control group in 30 days after operation.The mortality is 15.3%and 15.6%（p=0.88）.Ultrasound scanning of left ventricular end-diastole area and function,scanning of free fluid in body cavities,or lung prior to surgery doesn’t help for reducing the mortality in 30 days,neither in 90 days,half a year or one year for very critical emergency patients which meet our including criteria.Even so,we found ICU administration rate in ultrasound group（19.7%）was significant lower than control group（29.2%）.p=0.005.Patient’s age（odds ratio:6.26,95%confidence interval,;P=0.012）,NYHA classification 3（odds ratio,4.73;95%confidence interval,;P=0.03）,need artificial breath support（mask or intubated）before induction（odds ratio,10.47;95%confidence interval,;P=0.001）,surgical incision classification（odds ratio,9.49;95%confidence interval,;P=0.009）can be the strong predictors of 30 days death.Low SPO₂,low platelet,high heart rate and high white blood cell,will increase the chance of ICU administration post-operatively.Conclusions:Limited bedside ultrasound doesn’t help to improve the outcome in emergency critical surgical patient with instable hemodynamic or（and）respiratory condition,no matter whether it be in survival rate or in medical cost.Meanwhile,patients who are older,NYHA classification 3,with dirtier surgical incision and worse off oxygenation status need artificial ventilation before induction,has a lower chance to survival even after a medical treatment.ICU administration rate was also shown to have benefited in the ultrasound group.