Echocardiographic observations during inhospital cardiopulmonary resuscitation

Abstract

An echocardiographic examination is feasible during CPR and may offer useful information in the management of the individual patients with cardiac arrest. It may depict the proximate cause of cardiac arrest, e.g., pulmonary embolism, cardiac tamponade, or hypovolemia, and signal the return of ventricular contractions in patients with initially absent mechanical activity. The appearance of intracardiac coalescent echo contrast in our patients with unrelenting cardiac arrest was associated with a failed outcome. The role of echocardiographic imaging in the setting of advanced cardiac life support requires further study.

Part 12: Cardiac Arrest in Special Situations

“…[187][188][189][190][191][192][193][194] Despite the potential to increase the risk of severe bleeding, fibrinolytics may improve survival to discharge and long-term neurological function in patients with presumed PE-induced cardiac arrest. [193][194][195][196] Emergency echocardiography may be helpful in determining the presence of thrombus or PE.…”

Neurologically normal survival after fibrinolysis during prolonged cardiac arrest: case report and discussion

“…PEA is unique among cardiac arrest rhythms in that forward blood flow can occur. [13][14][15] This has prompted heightened vigilance for reversible causes when treating sustained PEA. 16 The possibility of low-grade cerebral and coronary perfusion during PEA supports the concept that a good outcome can result even with prolonged cardiac arrest if such a cause is addressed.…”

“…For a study to answer this question, it would have to be multicentre and either enroll an extremely large sample or utilize a modality, such as transthoracic or transesophageal echocardiography 13,14 or a decision rule 10 to enroll a population with a high probability of PE. It is clear from the "t-PA in PEA Study" that there is minimal, if any, benefit from t-PA in an undifferentiated PEA population.…”

Part 14: Pediatric Advanced Life Support

“…When appropriately trained personnel are available, echocardiography may be considered to identify patients with potentially treatable causes of the arrest, particularly pericardial tamponade and inadequate ventricular filling (Class IIb, LOE C). [155][156][157][158][159][160][161][162] Minimize interruption of CPR while performing echocardiography.…”