Electromechanical dissociation in human beings: An echocardiographic evaluation

Bocka, Joseph J.; Overton, David; Hauser, Andrew M.

doi:10.1016/s0196-0644(88)80234-8

Cited by 86 publications

(22 citation statements)

References 10 publications

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“…Previous research has demonstrated that as many as 87% of patients in PEA have myocardial wall and valve motion. 3 Our data confirm that a large percentage, 56%, of subjects with PEA do have cardiac activity and these PEA victims may be the most amenable to resuscitative therapy; the association between survival and sonographically detected cardiac activity in PEA subjects as compared with no cardiac activity was significant (p < 0.05). Our data support the hypothesis that the demonstration of cardiac standstill is associated with an unsuccessful resuscitation, whereas the detection of cardiac output is associated with an improved likelihood of survival.…”

Section: Discussionsupporting

confidence: 77%

“…Research has suggested that cardiac sonography may be beneficial in identifying patients with potentially treatable conditions and therefore better prognosis when central pulses are not palpable. [1][2][3][4][5][6] Since end-tidal carbon dioxide (ETCO 2 ) levels are dependent on the cardiac output generated by cardiopulmonary resuscitation in cardiac arrest victims, capnography represents another potential predictor of survival or death after cardiac arrest. 7 Both cardiac sonography and capnography are well suited to bedside emergency department (ED) practice in the care of critically ill patients because both tests are rapidly performed, noninvasive, and easily available.…”

mentioning

confidence: 99%

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Can Cardiac Sonography and Capnography Be Used Independently and in Combination to Predict Resuscitation Outcomes?

Salen

O’Connor

Sierzenski

et al. 2001

Academic Emergency Medicine

148

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Abstract. Objective: To measure the ability of cardiac sonography and capnography to predict survival of cardiac arrest patients in the emergency department (ED). Methods: Nonconsecutive cardiac arrest patients prospectively underwent either cardiac ultrasonography alone or in conjunction with capnography during cardiopulmonary resuscitation at two community hospital EDs with emergency medicine residency programs. Cardiac ultrasonography was carried out using the subxiphoid view during pauses for central pulse evaluation and end-tidal carbon dioxide (ETCO 2 ) levels were monitored by a mainstream capnograph. A post-resuscitation data collection form was completed by each of the participating clinicians in order to assess their impressions of the facility of performance and benefit of cardiac sonography during nontraumatic cardiac resuscitation. Results: One hundred two patients were enrolled over a 12-month period. All patients underwent cardiac sonographic evaluation, ranging from one to five scans, during the cardiac resuscitation. Fifty-three patients also had capnography measurements recorded. The presence of sonographically identified cardiac activity at any point during the resuscitation was associated with survival to hospital admission, 11/41 or 27%, in contrast to those without cardiac activity, 2/61 or 3% (p < 0.001). Higher median ETCO 2 levels, 35 torr, were associated with improved chances of survival than the median ETCO 2 levels for nonsurvivors, 13.7 torr (p < 0.01). The multivariate logistic regression model, which evaluated the combination of cardiac ultrasonography and capnography, was able to correctly classify 92.4% of the subjects; however, of the two diagnostic tests, only capnography was a significant predictor of survival. The stepwise logistic regression model, summarized by the area under the receiver operator curve of 0.9, furthermore demonstrated that capnography is an outstanding predictor of survival. Conclusions: Both the sonographic detection of cardiac activity and ETCO 2 levels higher than 16 torr were significantly associated with survival from ED resuscitation; however, logistic regression analysis demonstrated that prediction of survival using capnography was not enhanced by the addition of cardiac sonography.

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Section: Discussionsupporting

confidence: 77%

mentioning

confidence: 99%

Can Cardiac Sonography and Capnography Be Used Independently and in Combination to Predict Resuscitation Outcomes?

Salen

O’Connor

Sierzenski

et al. 2001

Academic Emergency Medicine

148

View full text Add to dashboard Cite

show abstract

“…[4][5][6][7] Sonography is particularly useful in the emergency diagnosis to rule out a mechanical cause of PEA arrest, such as cardiac tamponade, tension pneumothorax, or pulmonary embolism. 5,8,9 When massive pulmonary embolism is the cause of cardiac arrest, prompt administration of thrombolytic agents can be rapidly effective by restoring hemodynamic stability.…”

Section: Discussionmentioning

confidence: 99%

Sonographic diagnosis of pulmonary embolism with cardiac arrest without major dilation of the right ventricle or direct sign of lower limb venous thrombosis

Volpicelli

Mussa

Frascisco

2011

J of Clinical Ultrasound

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Bedside focused echocardiography diagnosis of massive pulmonary embolism during cardiac arrest is mainly based on the detection of a dilated right ventricle, while the lack of compressibility of a deep vein of the lower limbs confirms diagnosis in doubtful cases. We describe a case of unusual sonographic signs in a young woman with cardiac arrest due to massive pulmonary embolism showing spontaneous blood echogenicity in the inferior vena cava ("sludge sign") and nonmodulated ("flat") Doppler waveform in the left lower limb veins, suggesting isolated iliac vein thrombosis.

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“…5,6 The greatest potential role for echocardiography resides, however, in the immediate management of cardiac arrest with PEA. PEA has a much poorer prognosis than arrhythmic cardiac arrest 7-9 since it reflects either the terminal phase of pump failure such as following a massive infarction or is related to a major mechanical event which is not reversible unless specifically treated.…”

Section: Echocardiography-assisted Cprmentioning

confidence: 99%

Echocardiography During and After Resuscitation

Chenzbraun

2008

Emergency Echocardiography

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Electromechanical dissociation in human beings: An echocardiographic evaluation

Cited by 86 publications

References 10 publications

Can Cardiac Sonography and Capnography Be Used Independently and in Combination to Predict Resuscitation Outcomes?

Can Cardiac Sonography and Capnography Be Used Independently and in Combination to Predict Resuscitation Outcomes?

Sonographic diagnosis of pulmonary embolism with cardiac arrest without major dilation of the right ventricle or direct sign of lower limb venous thrombosis

Echocardiography During and After Resuscitation

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