Background: Early recognition management of hypotension reduce mortality, with point-of-care ultrasonography (POCUS) Rapid Ultrasound in Shock Hypotension (RUSH) protocol. This study aimed to assess effect of using of point-of-care ultrasonography protocol in patients with undifferentiated hypotension on survival outcomes in emergency intensive care unit (ICU).

Methods: This is a prospective randomized controlled clinical trial that was conducted on 100 adult patients who presented to Emergency ICU with undifferentiated, non-traumatic hypotension, or shock. The studied cases were randomly allocated into 2 groups (50 cases with POCUS 50 matched control group). The study's primary outcomes included mortality incidence, 30-day survival, hospital discharge rates. Secondary outcomes assess ICU/hospital stay duration, need for mechanical ventilation (MV), use of vasoinotropes fluids, CT scan rates, dialysis requirements.

Results: The use of POCUS significantly improved early diagnosis time (1.52±0.50 vs. 9.46±2.24 hours, p<0.001), reduced ICU stay (6.02±1.25 vs. 7.56±1.80 days, p<0.001), and decreased total IV fluid administration (9300 vs. 11000 mL, p=0.004) compared to control group. The POCUS group had higher systolic (114.10±3.45 vs. 112.30±4.42 mmHg, p=0.014), diastolic (65.40±4.27 vs. 61.70±2.39 mmHg, p<0.001), mean arterial pressures (81.54±3.38 vs. 78.39±2.33 mmHg, p<0.001) after 60 minutes. Mechanical ventilation duration was shorter in POCUS group (p<0.001). The CT scan use was lower in the POCUS group (20% vs. 48%, p=0.003).

Conclusion: Implementing POCUS protocol in emergency ICU for adult patients with undifferentiated, non-traumatic hypotension or shock significantly improved patient outcomes. POCUS reduced mean hospital discharge time, ICU length of stay, median IV fluid administration compared to the control group