Pre-hospital and emergency department point-of-care ultrasound in cardiovascular emergencies: a scoping review.
Cardiovascular Diagnosis and Therapy · 2026-06-15 · Scoping review
Abstract
BACKGROUND: Point-of-care ultrasound (POCUS) is integral to emergency department (ED) and pre-hospital medicine, yet evidence comparing its diagnostic and operational performance across environments remains fragmented, especially in cardiovascular emergencies. This review aimed to evaluate and compare the diagnostic performance, workflow impact, and clinical influence of POCUS for six major cardiovascular emergencies across pre-hospital and ED settings, while examining the effects of operator training, device technology, and governance structures. METHODS: A structured scoping review search was conducted using multiple electronic databases to identify adult studies evaluating pre-hospital or ED POCUS in cardiac arrest, cardiac tamponade, acute heart failure, shock, pneumothorax, and aortic dissection. Eligible designs included randomised, prospective, and observational studies reporting diagnostic accuracy, process efficiency, management impact, or outcomes. Data were synthesised comparatively rather than pooled. RESULTS: ED POCUS demonstrated high diagnostic accuracy (typically >85-90%) and shortened time to diagnosis or intervention by 30-70 minutes in acute heart failure, pneumothorax, tamponade, and dissection representing meaningful process improvements. However, as seen in conditions like undifferentiated shock, these process gains do not consistently translate into improved patient-centred outcomes such as survival or reduced hospital length of stay. Pre-hospital POCUS achieved adequate views in 70-90% of cases and frequently changed triage or destination decisions (10-50%), though mortality effects were neutral across studies with follow-up data. Cardiac-arrest POCUS provided strong prognostic value but required disciplined choreography to avoid interrupting compressions. Device miniaturisation and brief targeted training enabled field feasibility, while structured curricula, image archiving, and quality assurance (QA) underpinned safety and accuracy. CONCLUSIONS: POCUS consistently improves diagnostic efficiency and decision-making in both ED and pre-hospital settings. However, evidence that these gains translate into improved patient-centred outcomes remains limited. Future research should focus on protocolised POCUS pathways integrated with governance structures and system-level responses.
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