The S-I-C-C-A protocol: bedside ultrasound for rapid resuscitation of non-traumatic, undifferentiated shock in Department of Emergency Medicine

Prapa Bootta Bootta; Boriboon Chenthanakij; Borwon Wittayachamnankul; Krongkarn Sutham

Authors

Prapa Bootta Bootta Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Thailand
Boriboon Chenthanakij Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Thailand
Borwon Wittayachamnankul Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Thailand
Krongkarn Sutham Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Thailand

Keywords:

ultrasound, resuscitation, non-traumatic undifferentiated shock, protocol, Emergency Department, correct diagnosis rate, mortality

Abstract

Objective To study the use of “S-I-C-C-A”, a new bedside ultrasound approach protocol, which was developed in order to rapidly identify the cause of shock and guide for management of these patients in emergency department within the fi rst 30 minutes of arrival.

Methods We conducted a prospective historically-controlled study of patients age≥18 years old who had non-traumatic, undifferentiated shock in the Department of Emergency Medicine, Maharaj Nakorn Chiang Mai hospital. Data comparison between before and after S-I-C-C-A protocol implementation was done using descriptive statistical analysis. Primary
outcome was the correct diagnosis rate, compared between primary diagnosis and the fi nal hospital diagnosis. Secondary outcome were 7-day mortality rate, time spent in ED, and other relevant data retrieved from the protocol.

Results Data from the group before protocol implementation were retrospectively studied from January to April 2013, while data from the group after protocol implementation were prospectively studied from August to October 2013, and November 2015 for more additional populations. Both groups had data from 54 patients. The S-I-C-C-A protocol was
mostly used by 1st to 3rd year emergency residents (64.82%), in the median examination time of 10 (IQR 5-12.75) minutes could increase the correct diagnosis rate from 74.07% to 83.33% (p=0.119), and helped decreasing 7-day mortality rate from 27.78% to 16.67% (p=0.082).

Conclusion The use of S-I-C-C-A protocol, which is a step-by-step ultrasound approach, tends to increase the correct diagnosis rate and help guiding proper treatments in patients with undifferentiated shock within the fi rst 30 minutes, and may result in decreased 7-day mortality rate.

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