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

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.

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Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽

10.24908/pocus.v3i1.13310 ◽

2018 ◽

Vol 3 (1) ◽

pp. 13-14

Author(s):

Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽

Maryam Al Ali, MBBS

Keyword(s):

Emergency Department ◽

Critical Care ◽

Case Report ◽

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Critical Care Unit ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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

Circulation ◽

10.1161/circ.140.suppl_2.421 ◽

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.

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

CJEM ◽

10.1017/cem.2020.233 ◽

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.

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Forced diuresis oriented by point‐of‐care ultrasound in cardiorenal syndrome type 5 due to light chain myeloma—The role of hepatic venogram: A case report

Clinical Case Reports ◽

10.1002/ccr3.4069 ◽

2021 ◽

Author(s):

Andrea Galassi ◽

Lorenza Magagnoli ◽

Eliana Fasulo ◽

Andrea Stucchi ◽

Elena Restelli ◽

...

Keyword(s):

Case Report ◽

Light Chain ◽

Point Of Care ◽

Cardiorenal Syndrome ◽

Point Of Care Ultrasound ◽

Syndrome Type ◽

Forced Diuresis

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Point of care ultrasound in cardiac arrest: A case report of PE in PEA arrest

Journal of Radiology and Imaging ◽

10.14312/2399-8172.2017-5 ◽

2017 ◽

Vol 2 (4) ◽

pp. 36-39

Author(s):

Vitto CM ◽

Vitto MJ ◽

McCay BD ◽

Evans DP

Keyword(s):

Cardiac Arrest ◽

Case Report ◽

Point Of Care ◽

Point Of Care Ultrasound

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Point-of-care Ultrasound in Cardiac Arrest

Anesthesiology ◽

10.1097/aln.0000000000003811 ◽

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.

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Case Report: POCUS to FOCUS

POCUS Journal ◽

10.24908/pocus.v3i1.13311 ◽

2018 ◽

Vol 3 (1) ◽

pp. 15-17

Author(s):

Maryam Al Ali, MBBS ◽

Abeeha Gardezi, MBBsch ◽

Michael Jalal, MBBS ◽

Shihab Al Sheikh, MB.ChB. CABS. MRCS.

Keyword(s):

Emergency Department ◽

Critical Care ◽

Case Report ◽

Critical Care Unit ◽

Single Case ◽

Point Of Care ◽

Point Of Care Ultrasound

Point of care ultrasound (POCUS) plays an important role in the Emergency Department or in any Critical Care Unit. In our case, we present how a POCUS mnemonic guided us in diagnosing two fatal conditions in a single case.

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Point-of-care ultrasound in management of gallstone ileus – a case report

Medical Ultrasonography ◽

10.11152/mu-1731 ◽

2019 ◽

Vol 21 (2) ◽

pp. 197 ◽

Cited By ~ 1

Author(s):

Magda Iuliana Rotaru ◽

Alexandru Horia Necula ◽

Cosmin Nicolae Caraiani ◽

Alexandru Florin Badea ◽

Marcel Vasile Tantau ◽

...

Keyword(s):

Case Report ◽

Point Of Care ◽

Gallstone Ileus ◽

Abdominal Ultrasound ◽

Point Of Care Ultrasound ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Intestinal Obstructions

Point-of-care ultrasound has become of utmost importance in the management of critically ill patients, changing everyday clinical practice. With this case report, we highlight the role of abdominal ultrasound in the management of elderly patientswith gallstone ileus (a rare cause of intestinal obstructions caused by a cholecysto-duodenal fistula) and with contraindications for contrast-enhanced CT scan.

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The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

The Ultrasound Journal ◽

10.1186/s13089-021-00205-x ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Matthew G. Hanson ◽

Barry Chan

Keyword(s):

Pericardial Effusion ◽

Point Of Care ◽

Physical Exam ◽

Right Atrial ◽

Point Of Care Ultrasound ◽

X Ray ◽

Average Systolic Blood Pressure ◽

Time To Diagnosis ◽

Clinically Significant ◽

The Impact

Abstract Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

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