Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest

Zengin, Suat; Yavuz, Erdal; Al, Behçet; Cindoruk, Şener; Altunbaş, Gökhan; Gümüşboğa, Hasan; Yıldırım, Cuma

doi:10.1016/j.resuscitation.2016.02.025

Cited by 43 publications

(22 citation statements)

References 28 publications

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“…International guidelines recommend the use of point-of-care ultrasound, 1 which is extremely helpful in this timedependent context, being able to identify some of the treatable causes of cardiac arrest (Fig 2) and to guide the therapeutic approach. [2][3][4] The guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients accordingly recommend the use of ultrasound in case of PEA or asystolic CA. First, the physician should differentiate true PEA from pseudo-PEA 5 : the latter shows residual wall motion and may benefit from longer resuscitation, while true PEA has a poorer outcome.…”

Section: Discussionmentioning

confidence: 99%

“…6 Ultrasound should then differentiate potential treatable causes of CA. 4,5 Ultrasound may identify an acutely dilated RV corresponding to acute cor pulmonale, severely impaired LV frequently associated with ischemic disease, small and hyperkinetic ventricles indicating severe hypovolemia, or tamponade of the right-hand cavities by a pericardial effusion. 5 The findings should be confirmed in more than one view.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound Diagnosis of Cardiac Arrest in a Patient With Hematologic Disease

Mongodi

Luperto

Roldi

et al. 2019

Chest

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A 52-year-old woman suffered cardiac arrest (CA) while hospitalized in a hematologic ward. Her past medical history included breast cancer treated with radiotherapy and hormonal therapy, and acquired von Willebrand disease; she was undergoing testing for a newly detected severe thrombocytosis. Chest compressions were started immediately by nurses, followed by advanced cardiac life support (ACLS) started 4 min later, after the arrival of the intensivist. All rhythm checks showed nonshockable pulseless electrical activity (PEA) rhythm. Ultrasound was not available at that moment. Return to spontaneous circulation (ROSC) was obtained after 25 min; five doses of epinephrine were administered during resuscitation efforts. After ROSC, an ECG was negative for acute myocardial infarction and the patient was transferred to the ICU, intubated, and hemodynamically stable with no pharmacologic support. Once admitted to the ICU, while awaiting diagnostic in-depth analysis, she had a second CA; the cardiac monitor showed PEA. ACLS was immediately started and focused ultrasound was performed at the first pulse check pause.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound Diagnosis of Cardiac Arrest in a Patient With Hematologic Disease

Mongodi

Luperto

Roldi

et al. 2019

Chest

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“…Of course, these signs are a product of a large flow-obstructing PE altering hemodynamic physiology in the presence of spontaneous circulation, a factor that is not present at CA. However, several case reports and observational studies have reported that, even during CA, PE can still be identified using the same signs of disproportionate RV size and direct embolism visualization in the pulmonary artery, right atrium, or IVC as a homogenously echogenic structure independent of underlying anatomy (suggestive of thrombus presence [21][22][23][24][25]. Such findings may lead to change in management including use of thrombolysis, an intervention that could largely benefit mortality in these patients [26,27].…”

Section: Pulmonary Embolus With Acute Cor Pulmonalementioning

confidence: 99%

“…Case reports have shown handheld Doppler US devices can allow for faster pulse checks in patients during in-hospital CA [62]. Other authors have already reported the utility of US performed concomitantly with pulse palpation to be effective in identifying perfusing heart rhythms [21]. While US in this exact context is not yet well studied, it seems of little risk but some benefit to use US to eliminate some of this intrinsic inaccuracy in pulse palpation during CA resuscitation.…”

Section: Us To Guide Pulse Checksmentioning

confidence: 99%

Focused Sonography in Cardiac Arrest

Delaney¹,

Flora²,

Ahmad³

2017

Resuscitation Aspects

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Cardiac arrest (CA) is a high mortality event where the ability for clinicians to diagnose etiology and assess for intervention has a direct impact on patient outcomes. Bedside ultrasound (US) has emerged in current literature as a clinical tool to aid clinicians in CA resuscitation, though it remains underutilized. Reversible etiologies that can be efficiently diagnosed with US include tension pneumothorax, hypovolemia, pulmonary embolus with acute cor pulmonale, and cardiac tamponade. Other US findings may provide evidence in regard to prognosis. In this review, we present major applications of US in CA, compare existing protocols, and propose future research needs.

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“…[3, 5, 7, 8, 16] Some advocate using this to aid decision making, and in one prior work the only way in which POCUS findings altered treatment was in prompting the team to stop CPR when cardiac standstill was seen. [15] A systematic review however injects a note of caution, concluding that cardiac standstill “harbors a significantly lower (but not zero) likelihood that a patient will experience ROSC.” [6] The authors of the review conclude that POCUS can inform prognosis but should not be used in isolation to make decisions on stopping CPR.…”

mentioning

confidence: 99%