scholarly journals LO043: Is there an association between resuscitation effort and the use of cardiac ultrasound in patients arriving to the emergency department in cardiac arrest? The second Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHOC-ED 2) Study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S45-S45
Author(s):  
N. Beckett ◽  
P.R. Atkinson ◽  
J. Fraser ◽  
J. French ◽  
D. Lewis
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Endotracheal Intubation ◽  
Life Support ◽  
Point Of Care ◽  
Cardiac Activity ◽  
Advanced Cardiac Life Support ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Multiple Data

Introduction: The use of cardiac point of care ultrasound (PoCUS) to assess cardiac arrest patients is widespread, although not mandated by advanced cardiac life support (ACLS) guidelines. This study aims to examine if the use of ultrasound is associated with a difference in the length of resuscitation and the frequency of interventions during ACLS in the emergency department (ED). Methods: A retrospective database and chart analysis was completed for patients arriving to a tertiary ED in cardiac arrest, between 2010 and 2014. Patients were excluded if aged under 19, or with a previous DNR order. Patients were grouped based on whether PoCUS was used during ACLS (PoCUS group) and those without PoCUS (control group). Multiple data were abstracted from charts using a standardized form. Data was analyzed for the length of resuscitation, frequency of common ACLS interventions such as endotracheal intubation, administration of epinephrine, and defibrillation, as well as initial cardiac activity findings on PoCUS. Results: 263 patients met the study inclusion criteria, with 51 (19%) in the control group, and 212 (81%) in the PoCUS group. In the PoCUS group 23 (11%) had cardiac activity (Positive PoCUS) and 189 (89%) had no cardiac activity recorded. Positive PoCUS patients had longer mean resuscitation times (26.13 min, 95% CI 17.80-34.46 min) compared to patients with no PoCUS cardiac activity (12.63 min, 95% CI 11.07-14.19 min, p < 0.05) as well as to the control group (14.20 min, 95% CI 10.30-18.09 min, p < 0.05). Positive PoCUS patients were more likely to receive endotracheal intubation (91%, 95% CI 72-99%), and epinephrine (100%, 95% CI 85-100%) than patients with no PoCUS cardiac activity (ET: 47%, 95% CI 40-54%, p < 0.0001; Epi: 81%, 95% CI 75-86%, p < 0.0172) and than the control group (ET: 65%, 95% CI 50-78%, p < 0.0227; Epi: 80%, 95% CI 67-90%, p < 0.0258). There was no difference in numbers receiving defibrillation between groups. Conclusion: Our results suggest emergency physicians may be making increased resuscitative effort for patients with positive cardiac activity findings on PoCUS compared to those with negative findings or when no PoCUS was performed.

scholarly journals MP012: Is there an association between the use of cardiac ultrasound and survival outcomes in patients arriving to the emergency department in cardiac arrest? The second Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHOC-ED 2) Study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S70-S70
Author(s):  
N. Beckett ◽  
P.R. Atkinson ◽  
J. Fraser ◽  
J. French ◽  
D. Lewis
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Life Support ◽  
Point Of Care ◽  
Cardiac Activity ◽  
Advanced Cardiac Life Support ◽  
Control Group ◽  
Point Of Care Ultrasound

Introduction: The use of cardiac point of care ultrasound (PoCUS) to assess cardiac arrest patients is widespread, although not mandated by advanced cardiac life support (ACLS) guidelines. This study aims to examine if the use of ultrasound, along with the findings on ultrasound are associated with a difference in outcomes of cardiac arrest patients in the emergency department (ED). Methods: A retrospective database and chart analysis was completed for patients arriving to a tertiary ED in asystole or PEA cardiac arrest, between 2010 and 2014. Patients were excluded if aged under 19, or with a previous DNR order. Patients were grouped based on whether PoCUS was used during ACLS (PoCUS group) and those without PoCUS (control group). Multiple data were abstracted from charts using a standardized form. Data was analyzed for the return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD), as well as initial cardiac activity findings on PoCUS. Results: 230 patients met the study inclusion criteria, with 44 (19%) in the control group, and 186 (81%) in the PoCUS group. In the PoCUS group 20 (11%) had cardiac activity (Positive PoCUS) and 166 (89%) had no cardiac activity recorded. The control group had a higher rate of SHA than the PoCUS group (27%; 95% CI 15-43% vs. 10%: 6-15%, p = 0.0046), however there was no difference in frequency of ROSC (control: 37%; 24-55% vs. PoCUS 26%; 20-33%, p = 0.1373) or SHD (control: 7%, 95% CI 1-19%; PoCUS: 2%, 95% CI 0-5%, p = 0.0858). Positive PoCUS patients had a higher frequency of ROSC (75%; 50-91% vs. 20%; 15-27%, p < 0.001) and SHA (25%; 9-49% vs. 8%; 4-13%, p = 0.0294) than patients with no PoCUS cardiac activity, however there was no difference in the rate of SHD between the positive PoCUS patients (0%; 0-17%) and patients with no PoCUS cardiac activity (2%; 0-5%, p = 1.0000). Conclusion: Our results suggest that there is no difference in survival between cardiac arrest patients receiving PoCUS and those who do not. Although finding positive cardiac activity on PoCUS is associated with greater ROSC and survival to hospital admission, it does not identify patients with a final outcome of survival to hospital discharge.

scholarly journals LO045: Sonography in Hypotension and Cardiac Arrest (SHoC) - Cardiac Arrest: A consensus on the integration of point of care ultrasound into advanced cardiac life support during cardiac arrest

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S45-S46
Author(s):  
P. Atkinson ◽  
J. Bowra ◽  
J. Milne ◽  
M. Lambert ◽  
B. Jarman ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Cardiac Arrest ◽  
Life Support ◽  
Point Of Care ◽  
Cardiac Activity ◽  
Advanced Cardiac Life Support ◽  
Pericardial Tamponade ◽  
Point Of Care Ultrasound ◽  
International Consensus ◽  
Modified Delphi

Introduction: Point of care ultrasound (PoCUS) provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm. We consider that a consensus-based priority checklist using a “4 F’s” approach (Fluid; Form; Function; Filling), would provide a better algorithm during ACLS. Methods: The ultrasound subcommittee of the Australasian College for Emergency Medicine (ACEM) drafted a checklist incorporating PoCUS into the ACLS algorithm. This was further developed using the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. A modified Delphi tool was developed to reach an international consensus on how to integrate ultrasound into cardiac arrest algorithms for emergency department patients. Results: Consensus was reached following 3 rounds. The agreed protocol focuses on the timing of PoCUS as well as the specific clinical questions. Core cardiac windows performed during the rhythm check pause in chest compressions are the sub-xiphoid and parasternal cardiac views. Either view should be used to detect pericardial fluid, as well as examining ventricular form (e.g. right heart strain) and function, (e.g. asystole versus organized cardiac activity). Supplementary views include lung views (for absent lung sliding in pneumothorax and for pleural fluid), and IVC views for filling. Additional ultrasound applications are for endotracheal tube confirmation, proximal leg veins for DVT, or for sources of blood loss (AAA, peritoneal/pelvic fluid). Conclusion: The authors hope that this process will lead to a consensus-based SHoC-cardiac arrest guideline on incorporating PoCUS into the ACLS algorithm.

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.

Point-of-care Ultrasound in Cardiac Arrest

2021 ◽  
Author(s):  
Jonathan A. Paul ◽  
Oliver P. F. Panzer
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Point Of Care ◽  
Advanced Cardiac Life Support ◽  
Point Of Care Ultrasound

This review explains the role of point-of-care ultrasound in cardiac arrest rhythm classification and the diagnosis of reversible causes, discusses available protocols for the application of ultrasound to Advanced Cardiac Life Support, and summarizes principles for its safe implementation.

scholarly journals Strengthening Links in the “Chain of Survival”: A Singapore Perspective

2002 ◽  
Vol 9 (3) ◽  
pp. 121-125 ◽  
Author(s):  
Ra Charles ◽  
F Lateef ◽  
V Anantharaman
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Basic Cardiac Life Support ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
Mean Time ◽  
Hospital Cardiac Arrest ◽  
Ambulance Crew

Introduction The concept of the chain of survival is widely accepted. The four links viz. early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early Advanced Cardiac Life Support (ACLS) are related to survival after pre-hospital cardiac arrest. Owing to the dismal survival-to-discharge figures locally, we conducted this study to identify any weaknesses in the chain, looking in particular at bystander CPR rates and times to Basic Cardiac Life Support (BCLS) and ACLS. Methods and materials A retrospective cohort study was conducted in the Emergency Department of an urban tertiary 1500-bed hospital. Over a 12-month period, all cases of non-trauma out-of-hospital cardiac arrest were evaluated. Results A total of 142 cases of non-trauma out-of-hospital cardiac arrest were identified; the majority being Chinese (103/142, 72.5%) and male (71.8%) with a mean age of 64.3±7.8 years (range 23–89 yrs). Most patients (111/142, 78.2%) did not receive any form of life support until arrival of the ambulance crew. Mean time from collapse to arrival of the ambulance crew and initiation of BCLS and defibrillation was 9.2±3.5 minutes. Mean time from collapse to arrival in the Emergency Department (and thus ACLS) was 16.8±7.1 minutes. Three patients (2.11%) survived to discharge. Conclusion There is a need to (i) facilitate layperson training in bystander CPR, and (ii) enhance paramedic training to include ACLS, in order to improve the current dismal survival outcomes from out-of-hospital cardiac arrest in Singapore.

scholarly journals LO040: Do combined electrocardiogram rhythm and point of care ultrasound findings predict outcome during cardiac arrest? The second Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHOC-ED 2) Study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S43-S44
Author(s):  
N. Beckett ◽  
P.R. Atkinson ◽  
J. Fraser ◽  
J. French ◽  
D. Lewis
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Point Of Care ◽  
Cardiac Activity ◽  
Spontaneous Circulation ◽  
Final Outcome ◽  
Point Of Care Ultrasound ◽  
Negative Group ◽  
Positive Group ◽  
Negative Findings

Introduction: Survival to hospital discharge is better for PEA than asystole in out-of-hospital cardiac arrest. Point of care ultrasound (PoCUS) is widely used in cardiac arrest, although not mandated by ACLS guidelines. This study examines if initial PoCUS findings combined with cardiac rhythm are predictive of outcomes including return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and hospital discharge (SHD). 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 on PoCUS and PEA on ECG (Positive group); those with no cardiac activity recorded on PoCUS and asystole on ECG (Negative group); and those with a mix of positive and negative findings (Indeterminate group). Data was analyzed for the frequency of ROSC, SHA, and SHD. Results: 186 patients met the study criteria, with 14 (8%) in the positive group, 134 (72%) in the negative group, and 38 (20%) in the indeterminate group. The positive group had significantly better initial outcomes than the negative group: ROSC: 78% (95% CI 49-95%) vs 17% (11-25%); OR 17.70 (4.57-168.5; p < 0.0001) and SHA: 29% (8-58%) vs 7% (3-12%); OR 5.56 (1.45-21.28; p = 0.022), and then the combined negative and indeterminate groups: ROSC: 22% (16-29%), OR 12.93 (3.43-48.73; p < 0.0001; SHA: 8% (5-13%); OR 4.51 (1.25-16.27; p = 0.033). There was no difference between the positive group and either the negative or combined groups for final outcome of SHD: 0% (0-23%) vs 1% (0-5%); OR 1.83 (0.08-39.97; p = 1.00; and vs 1% (0-5%); OR 1.67 (0.08-33.96; p = 1.00). The negative group had worse initial outcomes than the combined positive and indeterminate groups: ROSC 17% (11-25%) vs. 50% (36-64%) OR 0.21 (0.10-0.42; p < 0.0001); SHA 6% (3-12%) vs. 8% (5-13%) OR 0.34 (0.13-0.92; p = 0.0490). There was no difference in SHD: 1% (0-5%) vs. 1% (0-5%) OR 0.77 (0.07-8.71; p = 1.00). Conclusion: Our results suggest that although finding positive cardiac activity on ECG (PEA) and also on PoCUS is associated with greater ROSC and SHA, it does not identify patients with a final outcome of SHD.

scholarly journals LO42: Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S22-S23
Author(s):  
E. Lalande ◽  
T. Burwash-Brennan ◽  
K. Burns ◽  
P. Atkinson ◽  
M. Lambert ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Likelihood Ratio ◽  
Point Of Care ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Cardiac Activity ◽  
World Health ◽  
Lower Sensitivity ◽  
Point Of Care Ultrasound

Introduction: Point-of-Care Ultrasound (PoCUS) is being increasingly utilized during cardiac arrests for prognosis. Following the publication of recent studies, the goal of this study was to systematically review and analyze the literature to evaluate the accuracy of PoCUS in predicting return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) in adult patients with non-traumatic, non- shockable out- of-hospital or emergency department cardiac arrest. Methods: A systematic review and meta-analysis was completed. A search of Medline, EMBASE, Cochrane, CINAHL, ClinicalTrials.gov and the World Health Organization Registry was completed from 1974 until August 24th 2018. Adult randomized controlled trials and observational studies were included. The QUADAS-2 tool was applied by two independent reviewers. Data analysis was completed according to PRISMA guidelines and with a random effects model for the meta-analysis. Heterogeneity was assessed using I-squared statistics. Results: Ten studies (1,485 participants) were included. Cardiac activity on PoCUS had a pooled sensitivity of 59.9% (95% confidence interval 36.5%-79.4%) and specificity of 91.5% (80.8%-96.5%) for ROSC; 74.7% (58.3%-86.2%) and 80.5% (71.7%-87.4%) for SHA; and 69.4% (45.5%-86.0%) and 74.6% (59.8%-85.3%) for SHD. The sensitivity of cardiac activity on PoCUS for predicting ROSC was 24.7%(6.8%-59.4%) in the asystole subgroup compared with 77% (59.4%-88.5%) within the PEA subgroup. Cardiac activity on PoCUS, compared to an absence had an odd ratio of 15.9 (5.9-42.5) for ROSC, 9.8 (4.9-19.4) for SHA and 5.7 (2.1-15.6) for SHD. Positive likelihood ratio (LR) was 6.65 (3.16-14.0) and negative LR was 0.27 (0.12-0.61) for ROSC. Conclusion: Cardiac activity on PoCUS was associated with improved odds for ROSC, SHA, and SHD among adults with non-traumatic asystole and PEA. We report lower sensitivity and higher negative likelihood ratio, but with greater heterogeneity compared to previous systematic reviews. PoCUS may provide valuable information in the management of non-traumatic PEA or asystole, but should not be viewed as the sole predictor in determining outcomes in these patients.

Reply to Letter: Letter to the Editor regarding Gaspari and colleague’s “Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest”

Resuscitation ◽  
2017 ◽  
Vol 114 ◽  
pp. e7-e8
Author(s):  
Romolo Gaspari ◽  
Anthony Weekes ◽  
Srikar Adhikari ◽  
Vicki E. Noble ◽  
Jason T. Nomura ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Letter To The Editor

Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest

Resuscitation ◽  
2016 ◽  
Vol 109 ◽  
pp. 33-39 ◽  
Author(s):  
Romolo Gaspari ◽  
Anthony Weekes ◽  
Srikar Adhikari ◽  
Vicki E. Noble ◽  
Jason T. Nomura ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Point Of Care ◽  
Point Of Care Ultrasound

scholarly journals European Resuscitation Council guidelines 2021: Adult advanced life support changes related to the guidelines 2015

2021 ◽  
Vol 7 (18) ◽  
pp. 298-303
Author(s):  
Srđan Nikolovski ◽  
Lovćenka Čizmović
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Point Of Care ◽  
Advanced Life Support ◽  
High Heart Rate ◽  
Point Of Care Ultrasound ◽  
European Resuscitation Council ◽  
Skilled Operator ◽  
New Guidelines

Adult advanced life support guidelines 2021 provided by the European Resuscitation Council in its largest extent do not differ significantly from equivalent guidelines published six years ago. However, some important points were further emphasized, and some protocols show new additions and structural changes. According to the new guidelines, there is a greater recognition that patients with both in-hospital and out-of-hospital cardiac arrest have premonitory signs, and that many of these arrests may be preventable. High-quality chest compressions with minimal interruption, early defibrillation, and treatment of reversible causes remained high priority steps in resuscitation process. New guidelines also recommend that, if an advanced airway is required, rescuers with a high tracheal intubation success rate should use this technique. With regard to using diagnostic procedures, medications, and special methods of cardiopulmonary resuscitation, newest guidelines also made new suggestions. According to these guidelines, when adrenaline is used, it should be used as soon as possible when the cardiac arrest rhythm is non-shockable, and after three defibrillation attempts for a shockable cardiac arrest rhythm. The guidelines recognise the increasing role of point-of-care ultrasound in peri-arrest care for diagnosis, but emphasis that it requires a skilled operator, and the need to minimise interruptions during chest compression. Additionally, 2015 guidelines suggested use of point-of-care ultrasound in diagnosing several various conditions with potential of causing cardiac arrest. However, 2021 guidelines limited indications in diagnosing only cardiac causes, such as tamponade or pneumothorax. The guidelines also reflect the increasing evidence for extracorporeal cardiopulmonary resuscitation as a rescue therapy for selected patients with cardiac arrest when conventional advanced life support measures are failing or to facilitate specific interventions. Additionally, newest guidelines made significant changes in the order of steps used in the In/hospital resuscitation algorithm, as well as changes in several very important steps of treating tachycardias and high heart rate associated arrhythmias.

Sign in / Sign up

Export Citation Format

Share Document