Ultrasound in postresuscitation care: a narrative review

Abstract

The efficacy of ultrasound (US) in real-time differential diagnosis and guiding further treatment decisions has been well demonstrated in prearrest conditions and during resuscitation. Evidence is limited regarding the application of US in postresuscitation care. Most of the patients following resuscitation remain comatose, and the requirement for transportation to other examination rooms increases their risk of injury. US can be performed at the bedside with high accessibility and timeliness without radiation. This narrative review provides an overview of current evidence regarding the application of US in identifying the cause of cardiac arrest (CA), hemodynamic monitoring, and prognostication in postresuscitation care. For identifying the cause of CA, cardiac US is mainly used to detect regional wall motion abnormality. However, postarrest myocardial dysfunction would confound the sonographic findings that a combination of electrocardiograms and biomarkers besides the cardiac US could improve the positive predictive value of coronary artery disease. For hemodynamic monitoring, left ventricular outlet tract velocity time integral has the best performance in predicting fluid responsiveness in conjunction with the passive leg raising test. The RUSH protocol assists in determining the subtypes of shock with high sensitivity and specificity in hypovolemic, cardiogenic, or obstructive shock. Evidence regarding the application of US for prognostication is still limited, and further evaluation should be needed.

Echocardiography in cardiac arrest: strengths and limitations

“…We agree with Hsu et al [1] that echocardiography helps in the prognostication of OHCA patients mainly by identifying the reversible cause of cardiac arrest. Indeed, patients with cardiac tamponade have the best prognosis, while those with myocardial standstill have the lowest chances of survival [10].…”

“…We truly appreciate the response from the readers regarding 'ultrasound in postresuscitation care' [1]. Lazzeri et al [2].…”

“…The narrative review by Hsu et al . [1] addressed quite a hot topic in emergency and critical care medicine, that is the application of ultrasound in identifying the cause of cardiac arrest (CA), hemodynamic monitoring and prognostication in postresuscitation care. The challenge of CA is represented by the very limited time allowed for identifying the cause (or the most likely causes) and, mostly, by the strict direct relation between a timely and efficacious treatment and neurologic recovery.…”

“…The paper by Hsu et al . [1] offers interesting insights into the specifics of echocardiography among the ultrasound methods. The knowledge of limitations and strengths of echocardiography (both transthoracic and transoesophageal) in a specific clinical context is pivotal in establishing its clinical role and effectiveness in that clinical condition.…”

“…The challenge of CA is represented by the very limited time allowed for identifying the cause (or the most likely causes) and, mostly, by the strict direct relation between a timely and efficacious treatment and neurologic recovery. The paper by Hsu et al [1] offers interesting insights into the specifics of echocardiography among the ultrasound methods. The knowledge of limitations and strengths of echocardiography (both transthoracic and transoesophageal) in a specific clinical context is pivotal in establishing its clinical role and effectiveness in that clinical condition.…”