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 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 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 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.

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 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.

scholarly journals Cardiopulmonary Resuscitation: Recent Advances

2020 ◽  
Author(s):  
Abhishek Kumar ◽  
Pratishtha Yadav ◽  
Rakesh Garg
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Time Management ◽  
Life Support ◽  
Point Of Care ◽  
Spontaneous Circulation ◽  
Current Evidence ◽  
Recent Advances ◽  
Cpr Training

Cardiac arrest is the most significant reason for mortality and morbidities worldwide. With a better understanding of the pathophysiology of cardiac arrest, simple adaptations in basic life support to upcoming modifications in post-resuscitation care have been proposed by various resuscitation councils throughout the globe. Role of point of care cardiac ultrasound during cardiopulmonary resuscitation (CPR) has been explored and its contribution for identifying reversible causes and its real time management has been explored. A higher blood and tissue oxygenation levels contributed to an increased rate of return of spontaneous circulation (ROSC) which has to lead us to explore more options to increase the oxygenation. Starting from the CPR training, the use of sensors for spirometric feedback in ventilation maneuvers can help improve the quality of CPR. High flow nasal oxygenation during CPR has shown promising results. Extracorporeal CPR is another entity that has shown survival benefits in a selected group of patients. The aim of the newer advances has always been to decrease the morbidity and improve survival outcomes in terms of neurological deficit as well. These guidelines are reviewed and updated regularly to improve knowledge and training based on the current evidence. This chapter shall focus on recent advances in cardiopulmonary resuscitation.

scholarly journals POCUS in cardiac arrest and its therapeutic implications – a case report

2021 ◽  
Vol 21 (84) ◽  
pp. e67-e69
Author(s):  
Wei Yang Lim ◽  
◽  
Kay Choong See ◽  
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Definitive Treatment ◽  
Point Of Care Ultrasound ◽  
Prognostic Role ◽  
Therapeutic Implications ◽  
The Impact

Point of Care Ultrasound is an increasingly popular modality in the emergency department as well as in the critical care unit. Its applications are varied, centered on its role in diagnosis, thereby minimizing the time taken for the appropriate diagnosis to be made and hence incorporate definitive treatment. There are currently no international guidelines published with regards for point of care ultrasound in the context of cardiac arrest. We propose to delineate the impact of the role of point of care ultrasound in a patient with cardiac arrest, in the evaluation of the cause, its prognostic role, as well as possible implications for therapies based on a case report.

scholarly journals Association of Drug Therapy with Survival in Cardiac Arrest: Limited Role of Advanced Cardiac Life Support Drugs

1995 ◽  
Vol 2 (4) ◽  
pp. 264-273 ◽  
Author(s):  
Ian G. Stiell ◽  
George A. Wells ◽  
Paul C. Hebert ◽  
Andreas Laupacis ◽  
Brian N. Weitzman
Keyword(s):  
Cardiac Arrest ◽  
Drug Therapy ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Limited Role

The Role of Emergency Nurses in Cardiopulmonary Resuscitation (CPR) of Cardiac Arrest Patients: A Literature Review

2021 ◽  
Vol 4 (1) ◽  
pp. 148-158
Author(s):  
Agus Sukarwan ◽  
Yuly Peristiowati ◽  
Agusta D. Ellina
Keyword(s):  
Cardiac Arrest ◽  
Literature Review ◽  
Emergency Room ◽  
Life Support ◽  
Selection Process ◽  
Advanced Cardiac Life Support ◽  
Review Literature ◽  
Emergency Nurses ◽  
Emergency Room Patients

Cardiac arrest can occur anywhere in the hospital area, whether it is in the emergency room, patients who are already in care, outpatients, the patient's family, visitors, or the community of the hospital at work. The literature of the review aims to determine the role of emergency nurses in the administration of pulmonary heart resuscitation in cardiac arrest patients. Literature review through several stages, namely making questions, identification, eligibility, selection of article inclusion, and screening. The Selection Process is listed in the framework of the review literature and obtained the results of article 8 articles. The data showed similar results related to the role of nurses in assisting cardiac arrest patients in hospitals. The results of the article in the review focused on the role of nurses in providing life support to patients with cardiac arrest, almost from all articles reviewed discussing the knowledge, experience, and skills of nurses in providing CPR. The role of nurses in the emergency room in providing life support to cardiac arrest patients is to improve the knowledge, experience, and skills in performing CPR. One way to improve the knowledge, experience, and skills of nurses in providing CPR to cardiac arrest patients is to participate in various training such as Basic Trauma Cardiac Life Support (BTCLS) or Advanced Cardiac Life Support (ATCLS).

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