scholarly journals Utility of Point-of-Care Ultrasound for In-Hospital Cardiac Arrest

CHEST Journal ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. A611
Author(s):  
Eric Bondarsky ◽  
Lina Miyakawa ◽  
Angela Love ◽  
Paru Patrawalla ◽  
Samuel Acquah ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Hospital Cardiac Arrest

scholarly journals Return of spontaneous circulation in patients with out-of-hospital cardiac arrest caused by pulmonary embolism using early point-of-care ultrasound and timely thrombolytic agent application: Two case reports

2020 ◽  
pp. 102490792096413
Author(s):  
Su Yeong Pyo ◽  
Gwan Jin Park ◽  
Sang Chul Kim ◽  
Hoon Kim ◽  
Suk Woo Lee ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Acute Pulmonary Embolism ◽  
Thrombolytic Agent ◽  
Point Of Care ◽  
Fibrinolytic Therapy ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Hospital Cardiac Arrest

Introduction: Acute pulmonary embolism is a confirmed cause of up to 5% of out-of-hospital cardiac arrest and 5%–13% of unexplained cardiac arrest in patients. However, the true incidence may be much higher, as pulmonary embolism is often clinically underdiagnosed. Thrombolytic therapy is a recognized therapy for pulmonary embolism–associated cardiac arrest but is not routinely recommended during cardiopulmonary resuscitation. Therefore, clinicians should attempt to identify patients with suspected pulmonary embolism. Many point-of care ultrasound protocols suggest diagnosis of pulmonary embolism for cardiac arrest patients. Case presentation: We describe two male patients (60 years and 66 years, respectively) who presented to the emergency department with cardiac arrest within a period of 1 week. With administration of point-of care ultrasound during the ongoing cardiopulmonary resuscitation in both patients, fibrinolytic therapy was initiated under suspicion of cardiac arrest caused by pulmonary embolism. Both patients had return of spontaneous circulation; however, only the second patient, who received fibrinolytic therapy relatively early, was discharged with a good outcome. In this report, we discussed how to diagnose and manage patients with cardiac arrest–associated pulmonary embolism with the help of point-of care ultrasound. We also discuss the different clinical outcomes of the two patients based on the experience of the clinicians and the timing of thrombolytic agent application. Conclusions: If acute pulmonary embolism is suspected in patients with out-of-hospital cardiac arrest, we recommend prompt point-of care ultrasound examination. Point-of care ultrasound may help identify patients with pulmonary embolism during cardiopulmonary resuscitation, leading to immediate treatment, although the clinical outcomes may vary.

scholarly journals LO33: Do electrocardiogram rhythm findings predict cardiac activity during cardiac arrest? A SHoC series study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S18-S18
Author(s):  
P. Atkinson ◽  
N. Beckett ◽  
D. Lewis ◽  
A. Banerjee ◽  
J. Fraser ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Predictive Value ◽  
Cardiac Rhythm ◽  
Point Of Care ◽  
Survival Rates ◽  
Cardiac Activity ◽  
Point Of Care Ultrasound ◽  
Likelihood Ratios ◽  
Series Study ◽  
Hospital Cardiac Arrest

Introduction: Electrocardiographic (ECG) rhythms are used during resuscitation (ACLS) to guide resuscitation, and often to determine futility. Survival rates to hospital discharge have been reported to be higher for patients with PEA than asystole in out-of-hospital cardiac arrest. This study examines how well the initial ECG cardiac rhythm represents actual cardiac activity as determined by point of care ultrasound (PoCUS). Methods: A database review was completed for patients arriving to a tertiary ED in asystole or PEA arrest, from 2010 to 2014. Patients under 19y or with a previous DNR were excluded. Patients were grouped into those with cardiac activity (PEA) and asystole on ECG; as well as whether cardiac activity was seen on PoCUS during the arrest. Data was analyzed for visualized cardiac activity on PoCUS. Results: 186 patients met the study criteria. Those with asystole on ECG were more likely to have no cardiac activity than those with PEA (Odds 7.21 for initial PoCUS; 5.45 for any PoCUS). The sensitivity of ECG rhythm was 80.49% and 82.12%, specificity was 77.91% and 54.28%, positive predictive value was 94.28% and 88.57%, and negative predictive value was 30.43% and 41.30% for cardiac activity on initial PoCUS and on any PoCUS respectively. The positive and negative likelihood ratios for ECG were 3.47 and 0.25 for activity on initial PoCUS. The positive and negative likelihood ratios for activity on any PoCUS were 1.78 and 0.33. Conclusion: Our results suggest that although most patients with asystole on ECG demonstrate no cardiac activity, a small number actually had activity on PoCUS. This supports the use of PoCUS during cardiac arrest, in addition to ECG, to identify patients with ongoing mechanical cardiac activity.

Point-of-Care Ultrasound Use by EMS Providers in Out-of-Hospital Cardiac Arrest

2022 ◽  
pp. 1-6
Author(s):  
Michael A. Kreiser ◽  
Brieanna Hill ◽  
Dikchhya Karki ◽  
Elke Wood ◽  
Ryan Shelton ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Patient Management ◽  
Point Of Care ◽  
Training Session ◽  
Point Of Care Ultrasound ◽  
Protocol Adherence ◽  
Video Acquisition ◽  
Advanced Airway ◽  
Hospital Cardiac Arrest ◽  
Adrenaline Administration

Abstract Aim: Paramedics received training in point-of-care ultrasound (POCUS) to assess for cardiac contractility during management of medical out-of-hospital cardiac arrest (OHCA). The primary outcome was the percentage of adequate POCUS video acquisition and accurate video interpretation during OHCA resuscitations. Secondary outcomes included POCUS impact on patient management and resuscitation protocol adherence. Methods: A prospective, observational cohort study of paramedics was performed following a four-hour training session, which included a didactic lecture and hands-on POCUS instruction. The Prehospital Echocardiogram in Cardiac Arrest (PECA) protocol was developed and integrated into the resuscitation algorithm for medical non-shockable OHCA. The ultrasound (US) images were reviewed by a single POCUS expert investigator to determine the adequacy of the POCUS video acquisition and accuracy of the video interpretation. Change in patient management and resuscitation protocol adherence data, including end-tidal carbon dioxide (EtCO2) monitoring following advanced airway placement, adrenaline administration, and compression pauses under ten seconds, were queried from the prehospital electronic health record (EHR). Results: Captured images were deemed adequate in 42/49 (85.7%) scans and paramedic interpretation of sonography was accurate in 43/49 (87.7%) scans. The POCUS results altered patient management in 14/49 (28.6%) cases. Paramedics adhered to EtCO2 monitoring in 36/36 (100.0%) patients with an advanced airway, adrenaline administration for 38/38 (100.0%) patients, and compression pauses under ten seconds for 36/38 (94.7%) patients. Conclusion: Paramedics were able to accurately obtain and interpret cardiac POCUS videos during medical OHCA while adhering to a resuscitation protocol. These findings suggest that POCUS can be effectively integrated into paramedic protocols for medical OHCA.

scholarly journals ReTEECA Trial. Rescue TransEsophageal Echocardiography for In-Hospital Cardiac Arrest.

2022 ◽  
Author(s):  
Asad Ali Usman ◽  
Samantha Stein ◽  
Audrey Spelde ◽  
Felipe Teran-merino ◽  
John Augoustides ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Arrest ◽  
Transesophageal Echocardiography ◽  
Hospital Discharge ◽  
Phase Ii ◽  
Point Of Care ◽  
Phase Ii Clinical Trial ◽  
Image Guided ◽  
Hospital Cardiac Arrest

Abstract This trial is aimed at studying the utility and interventional outcomes of rescue transesophageal echocardiography (RescueTEE) to aid in diagnosis, change in management, and outcomes during CPR by using a point of care RescueTEE protocol in the evaluation of in-hospital cardiac arrest (IHCA). This is an interventional prospective convenience sampled partially blinded phase II clinical trial with primary outcomes of survival to hospital discharge (SHD) with RescueTEE image guided ACLS versus conventional ACLS.

Abstract 421: Point of Care Ultrasound Sonography (POCUS) in Cardiac Arrest: Predicting Survivorship

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Ada Wong ◽  
Hassan Patail ◽  
Sahar Ahmad
Keyword(s):  
Cardiac Arrest ◽  
Tricuspid Valve ◽  
Prospective Observational Study ◽  
Thrombus Formation ◽  
Point Of Care ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Short Term ◽  
Flow Stasis

Introduction: Survival after in hospital (IH) cardiac arrest (CA) is at 17% suggesting that CA represents an arena of medical practice which deserves more attention. Ultrasound (US) may have a role in both intra-arrest management and peri-arrest prognosis. Very little is known about the role of ultrasound for IH CA. Hypothesis: Intra- arrest POCUS can provide prognostic value. Methods: This was a single center, prospective observational study and we included all IH CA which occurred when a provider was available to perform a standardized POCUS protocol. US and echocardiography imaging was collected during the intra- arrest period and compared with outcome measures of return of spontaneous circulation (ROSC) and survival to 24 hours post-ROSC. Results: Echocardiographic features which may reflect survivorship include cardiac standstill, right ventricle (RV) blood flow stasis, and the appearance of thrombus formation at or around the tricuspid valve. 10 of 16 (62.50%) patients with cardiac standstill alone and 1 of 3 (33.33%) RV stasis alone did not achieve ROSC. Of those that did achieve ROSC in these two groups, none of the patients survived beyond 24 hours of the CA. 11 of 19 (57.89%) patients with RV stasis in combination with cardiac standstill did not achieve ROSC, and of the remaining 8 patients that achieved ROSC, only 1 patient survived past 24 hours. The combination of cardiac standstill, RV stasis, and tricuspid valve thrombus had 2 of 3 (66.67%) patients fail to achieve ROSC, with the remaining 1 patient surviving only to 24 hours. The presence of cardiac standstill alone confers an association with death, with an odds ratio (OR) of 1.212. RV stasis plus cardiac standstill on intra-arrest POCUS confer a markedly higher OR 0.8250 in association with death. Conclusions: Our preliminary work brings to light the role of POCUS for predicting short term survivorship based on echocardiographic patient features. This may have implications for resource utilization in such events.

scholarly journals Do combined ultrasound and electrocardiogram-rhythm findings predict survival in emergency department cardiac arrest patients? The Second Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED2) study

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 739-743 ◽  
Author(s):  
Nicole Beckett ◽  
Paul Atkinson ◽  
Jacqueline Fraser ◽  
Ankona Banerjee ◽  
James French ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Point Of Care ◽  
Cardiac Activity ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Electrocardiogram Ecg ◽  
Higher Sensitivity

ABSTRACTObjectivesPoint-of-care ultrasound (POCUS) is used increasingly during resuscitation. The aim of this study was to assess whether combining POCUS and electrocardiogram (ECG) rhythm findings better predicts outcomes during cardiopulmonary resuscitation in the emergency department (ED).MethodsWe completed a health records review on ED cardiac arrest patients who underwent POCUS. Primary outcome measurements included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge.ResultsPOCUS was performed on 180 patients; 45 patients (25.0%; 19.2%–31.8%) demonstrated cardiac activity on initial ECG, and 21 (11.7%; 7.7%–17.2%) had cardiac activity on initial POCUS; 47 patients (26.1%; 20.2%–33.0%) achieved ROSC, 18 (10.0%; 6.3%–15.3%) survived to admission, and 3 (1.7%; 0.3%–5.0%) survived to hospital discharge. As a predictor of failure to achieve ROSC, ECG had a sensitivity of 82.7% (95% CI 75.2%–88.7%) and a specificity of 46.8% (32.1%–61.9%). Overall, POCUS had a higher sensitivity of 96.2% (91.4%–98.8%) but a similar specificity of 34.0% (20.9%–49.3%). In patients with ECG-asystole, POCUS had a sensitivity of 98.18% (93.59%–99.78%) and a specificity of 16.00% (4.54%–36.08%). In patients with pulseless electrical activity, POCUS had a sensitivity of 86.96% (66.41%–97.22%) and a specificity of 54.55% (32.21%–75.61%). Similar patterns were seen for survival to admission and discharge. Only 0.8% (0.0–4.7%) of patients with ECG-asystole and standstill on POCUS survived to hospital discharge.ConclusionThe absence of cardiac activity on POCUS, or on both ECG and POCUS together, better predicts negative outcomes in cardiac arrest than ECG alone. No test reliably predicted survival.

scholarly journals P025: Checking the pulse in the 21st century: inter-observer reliability of carotid pulse detection by point-of-care ultrasound

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S73-S74
Author(s):  
D. Smith ◽  
J. Chenkin ◽  
R. Simard
Keyword(s):  
Cardiac Arrest ◽  
Healthcare Provider ◽  
Point Of Care ◽  
Rank Test ◽  
Point Of Care Ultrasound ◽  
Current Standard ◽  
Observer Reliability ◽  
Pulse Palpation ◽  
Before And After ◽  
The Impact

Introduction: Detection of a pulse is crucial to decision-making in the care of patients who are in cardiac arrest, however, the current standard of manual pulse palpation is unreliable. An emerging alternative is the use of point-of-care ultrasound (POCUS) for direct assessment of the carotid pulse. The primary objective of this study is to determine the inter-observer reliability for healthcare provider interpretation of the carotid pulse by POCUS in patients who are peri-arrest or in cardiac arrest. Methods: We conducted a web-based survey of healthcare providers. Participants were shown a tutorial demonstrating POCUS detection of the carotid pulse and then asked to interpret 15 carotid pulse ultrasound clips from patients who were peri-arrest or in cardiac arrest. The primary outcome was inter-observer reliability for carotid pulse assessment. Secondary outcomes included inter-observer reliability stratified by healthcare provider role and POCUS experience, mean tutorial duration, mean pulse assessment duration, rate of pulse assessments < 10 seconds, and change in participant confidence before and after the study. Inter-observer reliability was determined by Krippendorff's α. Change in participant confidence was determined by Wilcoxon signed-rank test. Results: 68 participants completed our study, with a response rate of 75% (68/91). There was near perfect inter-observer reliability for pulse assessment amongst all study participants (α=0.874, 95% CI 0.869, 0.879). Senior residents (n = 24) and POCUS experts (n = 6) demonstrated the highest rates of inter-observer reliability, α=0.902 (95% CI 0.888, 0.914) and α=0.925 (95% CI 0.869, 0.972), respectively. All sub-groups had α greater than 0.8. Mean tutorial duration was 31 seconds (SD = 17.5) with maximum duration of 55 seconds. Mean pulse assessment duration was 7.7 seconds (SD = 5.2) with 76% of assessments completed within 10 seconds. Participant confidence before and after the study significantly increased from a median of 2 to a median of 4 on a 5-point Likert-type scale (z = 6.3, p < .001). Conclusion: Interpretation of the carotid pulse by POCUS showed near perfect inter-observer reliability for patients who were peri-arrest or in cardiac arrest. Participants required minimal training and indicated improved POCUS pulse assessment confidence after the study. Further work must be done to determine the impact of POCUS pulse assessment on the resuscitation of patients in cardiac arrest.

Point-of-Care lab in out-of-hospital cardiac arrest: The incidence of hyperkalaemia and hypokalaemia

Resuscitation ◽  
2018 ◽  
Vol 130 ◽  
pp. e23
Author(s):  
Susanne Betz ◽  
Tobias Grübl ◽  
Martin Sassen ◽  
Birgit Markus ◽  
Clemens Kill
Keyword(s):  
Cardiac Arrest ◽  
Point Of Care ◽  
Hospital Cardiac Arrest
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