The role of point of care ultrasound in prehospital critical care: a systematic review

Point-of-care ultrasound (POCUS) has been identified as a top research priority for prehospital critical care. This systematic review evaluated 27 studies published between 2012 and 2017 to assess the feasibility of prehospital POCUS, its impact on patient management, and the educational requirements for providers.

The review found that POCUS is feasible in the prehospital setting across several critical conditions. In trauma, it helps identify pneumothorax and hemoperitoneum, often changing treatment plans. For patients with breathing difficulties, POCUS is useful for ruling out congestive heart failure. In cardiac arrest, POCUS can distinguish between cardiac activity and standstill; however, the authors caution that it may lead to prolonged, detrimental pauses in chest compressions. Notably, no studies compared patient survival or other clinical outcomes between patients who received POCUS and those who did not.

Effective POCUS implementation requires significant training. While short courses can teach basic interpretation, they are insufficient for image acquisition. The evidence suggests that a robust educational program—combining theoretical learning, hands-on training, and a minimum of 50 supervised clinical examinations—is necessary to achieve the level of expertise required for clinical practice. Physician experience is a significant factor in the quality and interpretability of the images obtained.

While POCUS is increasingly used in prehospital care, its adoption has outpaced the evidence regarding its impact on patient survival. This review highlights that while POCUS can guide immediate triage and management, it should not be viewed as a definitive diagnostic tool that replaces standard clinical judgment, particularly in time-sensitive scenarios like cardiac arrest. Future research must move beyond diagnostic accuracy to focus on patient-centered outcomes and the specific clinical questions that POCUS can reliably answer in the field.