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Practice Editing Here (Nov 15th in-class Wiki session work)

Cardiac Arrest

• This is a place to practice clicking the "edit" button and practice adding references (via the citation button).

Task:

1. Find a peer-reviewed journal article on PubMed. Practice inserting your citation in the above space using the "cite" tool
2. Choose one "B-level" medical article on Wikipedia from the following list: https://wp1.openzim.org/#/project/Medicine/articles?quality=B-Class&importance=High-Class
3. Practice editing live on Wikipedia by finding a typo in the text or improving the clarity/readability of a sentence by adjusting a few words in a sentence.

Assignment # 3- please post an anonymous copy here!

Original Wikipedia sentence:

In many cases, lack of a carotid pulse is the gold standard for diagnosing cardiac arrest, as lack of a pulse in the periphery (radial/pedal) may result from other conditions (e.g. shock), or simply an error on the part of the rescuer. Nonetheless, studies have shown that rescuers often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals or lay persons.

Proposed changes

Adding after the final original wikipedia sentence (above): Point-of-care ultrasound (POCUS) is a tool that can be used to examine the movement of the heart and its force of contraction at the bedside of a patient experiencing cardiac arrest. POCUS can accurately diagnose cardiac arrest in hospital settings, overcoming some of the shortcomings of diagnosis through checking the central pulse (carotid arteries or subclavian arteries), as well as detecting movement and contractions of the heart.

Using POCUS, clinicians can have limited, two-dimensional views of different parts of the heart during arrest. These images can help clinicians determine whether electrical activity within the heart is pulseless or pseudo-pulseless, as well as help them diagnose the potentially reversible causes of an arrest. Published guidelines from the American Society of Echocardiography, American College of Emergency Physicians, European Resuscitation Council, and the American Heart Association, as well as the 2018 preoperative Advanced Cardiac Life Support guidelines, have recognized the potential benefits of using POCUS in diagnosing and managing cardiac arrest.

Rationale for proposed change

The wikipedia article indicates that the carotid pulse check is the gold standard for cardiac arrest diagnosis and that both healthcare professionals and lay individuals often do not conduct an accurate assessment of the presence/absence of the carotid pulse. The wikipedia article does not go on to expand how healthcare professionals and lay individuals can improve the accuracy of this assessment, leaving the wikipedia reader confused about how an accurate diagnosis is made. Recent developments have demonstrated that POCUS is an excellent way of measuring central pulses and monitoring cardiac activity. Additionally, POCUS has been increasingly used by clinicians as a diagnostic tool for determining the underlying causes of cardiac arrest, with the images collected used to inform management strategies and/or treatment plans. Additional information on the availability and usage of POCUS within healthcare settings helps the reader understand that professionals can accurately and confidently diagnose cardiac arrest, as well as its underlying causes, with this new technology. Although this is not a direct edit to the original wikipedia sentences, this is a significant development in medicine that is widely used by healthcare professionals.

Controversies expected

Expected controversies with our addition to the ‘Diagnostic’ section of the ‘Cardiac arrest’ article will most likely relate to the efficacy of POCUS as a diagnostic and management tool, as well as its potential interference with resuscitation efforts. In support of our position, we refer to the numerous guidelines that have advocated for the incorporation of POCUS into regular diagnostic and management processes for cardiac arrest, however it is important to note that these guidelines also acknowledge that more data are required to assess its efficacy. Such guidelines also emphasize the importance of ensuring that the use of POCUS during cardiopulmonary resuscitation (CPR) efforts doesn’t introduce pauses of more than 10 seconds between compressions. The authors of Paul & Panzer (2021), one of the references that we will be citing for the information we will be adding to our wikipedia page, also cite evidence suggesting that introduction of POCUS in during CPR may lead to longer pauses between compressions during CPR. However, the authors of our reference article note that numerous protocols exist, including the Focused Echocardiographic Evaluation in Resuscitation (FEER) protocol, which outlined key steps that have been conserved in subsequently developed protocols.

Controversies expected in terms of checking carotid pulse may include conducting assessments in ambulatory or non-healthcare based settings. It is important to note that POCUS is not readily available outside of the hospital and the nature of cardiac arrest requires an immediate initiation of resuscitation efforts. On an outpatient basis or within non-healthcare settings, using POCUS for pulse checks may not be feasible. Even if POCUS instruments become available alongside defibrillators and first-aid kits, user training and expenses are important caveats to consider. The selected article does emphasize its use in hospital-based settings, however it is important to note that the reliance on auscultating and palpating the carotid may still be the primary form of pulse-checking in non-hospital based environments.

Critique of Sources

Source 1: Long, B., Alerhand, S., Maliel, K., & Koyfman, A. (2018). Echocardiography in cardiac arrest: An emergency medicine review. The American journal of emergency medicine, 36(3), 488–493. https://doi.org/10.1016/j.ajem.2017.12.031

Long et al. (2018) is a review article surrounding the use of echocardiography in cardiac arrest— specifically the use of point-of-care ultrasound, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the assessment, diagnosis and monitoring of cardiac arrest. This is a recent article (2018) with 79 citations from high-quality journals, indicative of the authors conducting a thorough review of the current POCUS and echocardiography literature available. The authors dedicated a section to conflicts of interest of which there were none indicated. The acknowledgements section indicated that no grants were used, the review was not published elsewhere and has not been published in abstract form— further indicating low potential levels of bias. One of the major limitations of this study was the usage of POCUS and echocardiography showed no improvement in mortality at the time the research was conducted. Additionally, the usage of POCUS is only available in hospital-based settings, and therefore the accuracy of pulse checks on an outpatient basis still remains limited.

The literature still illustrates promising results for POCUS and echocardiography usage as a diagnostic and prognostic tool. This served the purpose of improving the current information in the Wikipedia page on cardiac arrest. This information is also consistent with recent literature identifying POCUS as a hospital standard in diagnosing cardiac arrest.

Source 2: Paul, J. A., & Panzer, O. P. F. (2021). Point-of-care Ultrasound in Cardiac Arrest. Anesthesiology, 135, 508–519. https://doi.org/10.1097/ALN.0000000000003811

Paul & Panzer (2021) is a narrative review of the literature concerning the use of point-of-care ultrasound (POCUS) in cardiac arrest. The authors were very thorough in performing their review of the literature, including nearly 83 citations in total for the information presented throughout. However, as the article is not a systematic review, it is not possible to know to assess whether the author’s search strategy was biased towards searching for articles that only presented favourable evidence for the use of POCUS in diagnosis and management of cardiac arrest. Furthermore, the lack of a set of priori and explicit inclusion/exclusion criteria makes it unclear on what basis the authors decided to include articles in their review, as well as what articles were reviewed and excluded (if any), making it impossible to assess potential article selection bias. However, the authors do report that some studies found negative or controversial results for the use of POCUS in cardiac arrest, which lends support for the notion that the potential cons or drawbacks of the intervention were investigated by the authors in their review of the literature. For example, the authors do note that the efficacy of POCUS in improving cardiac arrest patient outcomes is still under investigation, and that numerous studies and guidelines have raised concerns regarding the possible interruptions that POCUS may introduce in clinicians’ resuscitation efforts.

Despite these drawbacks, the article is written in an objective, informative tone that appears to present the facts about POCUS and its potential for observing gross pathologies of the heart and thorax during cardiac arrest. The information is supported by credible sources, including several guideline documents from reputable organizations such as the American Heart Association. It has been published in a reputable, peer-reviewed journal. The information is current and relevant to the topic at hand. Finally, the authors appear to be experts in the field of anesthesia, with one author having published a number of articles regarding the use of various imaging modalities during cardiac surgeries. At the end of the article, the authors declare that they have no conflicts of interest.

What to post on the Wikipedia article talk page (part of assignment 3)

• This will also be covered on Nov 15th in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
• You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
• Talk Page Template: Wikipedia:CARL Medical Editing Initiative/Fall 2021/Talk Page Template