The effects of preoperative focused cardiac ultrasound in high-risk patients: A randomised controlled trial (PREOPFOCUS).

BACKGROUND: Surgery is the third most common cause of mortality worldwide. Focused cardiac ultrasound (FOCUS) yields information on cardiac status and discloses the presence of unknown pathology. Preoperative FOCUS changes patient treatment, allowing for a patient-tailored anaesthesia. We hypothesised that preoperative FOCUS would reduce the proportion of patients who were either admitted to hospital for more than 10 days or who were dead within 30 days after high-risk, non-cardiac surgery. METHODS: This was a randomised, controlled, multi-center study. Patients ≥65 years of age, admitted for urgent orthopaedic- or abdominal surgery, scheduled for general- or neuraxial anaesthesia and with ASA 3/4 were eligible for inclusion. Patients were randomised in a 1:1 ratio to preoperative FOCUS or no preoperative FOCUS performed in accordance with a predefined protocol. Primary endpoint was the proportion of patients admitted more than 10 days or who were dead within 30 days. Secondary endpoints included major complications, days of admission and changes in anaesthesia handling. RESULTS: During the second COVID-19 wave the study monitoring committee terminated the study prematurely. We included 338 patients of which 327 were included in the final analysis. In the FOCUS group, 41/163 (25%) patients met the criteria for the primary endpoint versus 35/164 (21%) for the control group, adjusted odds ratio 1.37 (95% CI 0.86-2.30), p = .36. The proportions of patients who developed major complications did not differ significantly between groups. Length of hospital stay was 4 (3-8) days in the FOCUS group and 4 (3-7) days on the control group (adjusted p = .24). CONCLUSION: The routine availability of preoperative FOCUS assessment in this cohort does not appear to reduce the risk for hospitalisation exceeding 10 days or 30-day mortality, although study enrolment was prematurely terminated.

The effects of preoperative point-of-care focused cardiac ultrasound in high-risk patients: study protocol for a prospective randomised controlled trial.

INTRODUCTION: Perioperative mortality and morbidity remain substantial in acute surgery. Risk factors include known cardiovascular disease, but preoperative screening is insensitive to occult cardiopulmonary conditions. Focused cardiac ultrasound (FOCUS) can disclose both structural and functional cardiac disease and provides insight into the patient's haemodynamic status. This study aims to clarify whether preoperative FOCUS changes clinical outcomes in high-risk patients. METHODS: This is a multi-centre, randomised, controlled, prospective study including patients ≥ 65 years of age scheduled for acute/emergency abdominal- or orthopaedic surgery. A total of 800 patients will be randomised to ± application of preoperative FOCUS. The primary endpoint is the proportion of patients admitted to hospital > 10 days or death within 30 days of surgery. The secondary endpoints include changes in the anaesthesia approach facilitated by FOCUS, biomarkers of organ function and perioperative complications. CONCLUSIONS: The knowledge generated from this study may facilitate changes in the anaesthesia evaluation and decision process and, consequently, in the entire perioperative anaesthesia clinical practice. The study has the potential to reduce the risk of perioperative cardiopulmonary complications which directly implies improved patient outcome and reduced hospital costs. FUNDING: The Research Fund of the Department of Anaesthesiology, Randers Regional Hospital, The Central Denmark Region's Medical Research Fund and the Hospital of Southern Jutland. TRIAL REGISTRATION: NCT03501927.

[From accident to trauma center--the lapse of time for patients with severe head injuries]. / Fra ulykke til traumecenter--tidsforløb for patienter med alvorlig hovedskade.

INTRODUCTION: Early neurosurgical intervention and specialised neurointensive care have been shown to decrease morbidity and mortality in cases of severe head injury. This makes quick or direct transfer to a trauma centre essential. The aim of this study was to investigate the time from the time of the accident required for secondarily transferred patients with head injury to arrive at the trauma centre in Aarhus. MATERIALS AND METHODS: This was a descriptive study based on consecutive data on patients secondarily transferred to Aarhus Trauma Centre in 2003. Only patients with head injury admitted to the neurosurgical intensive care unit were included. The time of the accident was defined as the time of dispatch of the ambulance. RESULTS: A total of 89 patients were transferred secondarily to the trauma centre in Aarhus 2003; 43 of these had head injury. The median Glasgow Coma Score was 6.5 (3-15). The median time from accident to arrival at the trauma centre was 3 hours and 50 minutes (44 minutes to 20 hours, 4 minutes), and 42% of the patients arrived later than 4 hours after the injury. The distance from the primary hospital to the trauma centre was between 1.9 and 172 kilometers, and there was no association between distance and time. DISCUSSION: The time from accident to arrival at the trauma centre was long, considering the severity of the injuries and the short distances involved. Direct transfer from the site of accident to the trauma centre would almost certainly improve the time. This study gives a reference value for the Danish trauma system.