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Gould J, Marshall R, French D, Dyer-Heynen M, Olszynski P. Comparing sternal versus left-sided chest compressions for thoracoabdonimal injuries and compression biomechanics: A clinical-grade cadaver study. Resusc Plus 2025; 21:100865. [PMID: 39897062 PMCID: PMC11786900 DOI: 10.1016/j.resplu.2025.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 01/02/2025] [Accepted: 01/02/2025] [Indexed: 02/04/2025] Open
Abstract
Background The lower half of the sternum is currently recommended as the area of compression (AOC) in CPR. Compressions over this area often result in outflow obstruction and inadequate compression of the left ventricle. Alternative left-sided chest compressions that target the left ventricle may improve cardiac arrest outcomes. However, little is known about the risks of thoracoabdominal injuries or the biomechanics of left-sided compressions. Methods The objective of this study was to examine the thoracoabdominal injury patterns and compression biomechanics during standard (control) and left-sided (experimental; off sternum, patient left, 6th rib) chest compressions. N = 6 clinical-grade cadavers (control n = 2; experimental n = 4) underwent six 2-minute rounds of chest compressions with intermittent fluoroscopy. Chest compression depth, recoil, and rate were standardized using compression feedback devices. Post-CPR dissection was used to examine for thoracoabdominal injuries. Results Standard compressions resulted in rib fractures (n = 1 [50%]). Left-sided compressions resulted in rib fractures (n = 4 [100%]), flail chest segments (n = 3 [75%]), and internal thoracic artery injury (n = 1 [25%]). No abdominal organ injuries were identified in either group (N = 6 [0%]). During compression, each condition yielded a different pattern of chest wall deformity (standard - regular trapezoid [midline, comparable left-right sides, flat top, and bottom]; left-sided - irregular trapezium [left-sided, unequal sides, leftward sloped top]). Conclusion Experimental left-sided compressions consistently produced rib fractures and flail chest segments. Findings should be interpreted with caution due to the limited sample size. Further studies investigating the biomechanics and outcomes of left sided chest compressions are warranted.
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Affiliation(s)
- J. Gould
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - R.A. Marshall
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - D. French
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - M. Dyer-Heynen
- Department of Internal Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - P. Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Gu Y, Panda K, Spelde A, Jelly CA, Crowley J, Gutsche J, Usman AA. Modernization of Cardiac Advanced Life Support: Role and Value of Cardiothoracic Anesthesiologist Intensivist in Post-Cardiac Surgery Arrest Resuscitation. J Cardiothorac Vasc Anesth 2024; 38:3005-3017. [PMID: 39426854 PMCID: PMC11801484 DOI: 10.1053/j.jvca.2024.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/07/2024] [Accepted: 09/18/2024] [Indexed: 10/21/2024]
Abstract
Cardiac arrest in the postoperative cardiac surgery patient requires a unique set of management skills that deviates from traditional cardiopulmonary resuscitation and Advanced Cardiovascular Life Support (ACLS). Cardiac Advanced Life Support (CALS) was first proposed in 2005 to address these intricacies. The hallmark of CALS is early chest reopening and internal cardiac massage within 5 minutes of the cardiac arrest in patients unresponsive to basic life support. Since the introduction of CALS, the landscape of cardiac surgery has continued to evolve. Cardiac intensivists encounter more patients who undergo cardiac surgical procedures performed via minimally invasive techniques such as lateral thoracotomy or mini sternotomy, in which an initial bedside sternotomy for cardiac massage is not applicable. Given the heterogeneous nature of the patient population in the cardiothoracic intensive care unit, personnel must expeditiously identify the most appropriate rescue strategy. As such, we have proposed a modified CALS approach to (1) adapt to a newer generation of cardiac surgery patients and (2) incorporate advanced resuscitative techniques. These include rescue-focused cardiac ultrasound to aid in the early identification of underlying pathology and guide resuscitation and early institution of extracorporeal cardiopulmonary resuscitation instead of chest reopening. While these therapies are not immediately available in all cardiac surgery centers, we hope this creates a framework to revise guidelines to include these recommendations to improve outcomes and how cardiac anesthesiologist intensivists' evolving role can aid resuscitation.
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Affiliation(s)
- Yang Gu
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY.
| | - Kunal Panda
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY
| | - Audrey Spelde
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Christina Anne Jelly
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Jerome Crowley
- Department of Anesthesiology, Pain Medicine, and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Asad Ali Usman
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
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3
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Bianconi K, Hanna M, Visveswaran G, Patel R, Pompa J, Glucksman A, Cavaliere G, Steenberg M, Tagore A, Ariyaprakai N. Retrospective Review of the Image Quality of Monoplane Transesophageal Echocardiography in Prehospital Out-of-Hospital Cardiac Arrest: A Single Center Pilot Study. PREHOSP EMERG CARE 2024:1-6. [PMID: 39387637 DOI: 10.1080/10903127.2024.2411720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/26/2024] [Accepted: 09/27/2024] [Indexed: 10/15/2024]
Abstract
OBJECTIVES Out of Hospital Cardiac Arrest (OHCA) is a frequently encountered pathology with resultant poor outcomes in the majority of patients. Echocardiography has been utilized to help guide clinical decision making and monitor effectiveness of resuscitative efforts. Transthoracic echocardiography (TTE) the mainstay of point-of-care ultrasound (POCUS) real time resuscitative imaging has limitations, most notably is the disruption of closed chest compressions. Trans-esophageal echocardiography (TEE) is an emerging technology in emergency care and can potentially overcome these limitations but image quality and accuracy of use in the prehospital environment remains unknown. Our primary objective is to identify the accuracy of Emergency Medical Services (EMS) fellow physicians in performing TEE via the identification of key cardiac structures. Secondarily we assess image quality as well as accuracy on cardiac activity interpretation as compared to TEE-experienced cardiologists. METHODS A pilot study using descriptive analysis of a retrospective case-series with specific focus on inter-rater reliability as well as pragmatic management alterations based on real-time image interpretation by EMS physicians. After focused education, 13 patients were eligible for prehospital TEE who suffering OHCA from July 2022 to June 2023. Ultrasound (US) images were interpreted by EMS fellow physicians and over-read by cardiologists with specific focus on inter-rater reliability. After collection of patients presenting data and US images, analysis was performed. RESULTS Of 13 patients initially screened, 10 patients were included in a study with a median age of 50 years old (41-70). Three patients were excluded due to equipment malfunction or insufficient image capture. An interrater reliability identified a kappa of 0.96 with respect to identification of cardiac structures and a kappa of 0.65 for identification of cardiac activity. CONCLUSIONS In this small study of prehospital TEE, EMS fellow physicians had high inter-rater reliability in image interpretation pertaining to anatomy and cardiac activity when compared with cardiologists. Further research is needed to determine its efficacy, safety, and widespread application in the prehospital setting.
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Affiliation(s)
- Kristopher Bianconi
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Mark Hanna
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Gautam Visveswaran
- Department of Cardiology, Newark Beth Israel Medical Center, Jersey, Newark, New Jersey
| | - Reenal Patel
- Department of Cardiology, Newark Beth Israel Medical Center, Jersey, Newark, New Jersey
| | - Joseph Pompa
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Alec Glucksman
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Garrett Cavaliere
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Matthew Steenberg
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Ammundeep Tagore
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Navin Ariyaprakai
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
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4
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Lin F, Wu C, Chen C. Bradycardia in a woman. J Am Coll Emerg Physicians Open 2024; 5:e13336. [PMID: 39430667 PMCID: PMC11486799 DOI: 10.1002/emp2.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 10/01/2024] [Indexed: 10/22/2024] Open
Affiliation(s)
- Fang‐Yu Lin
- Department of Emergency MedicineKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
| | - Chan‐Han Wu
- Department of Emergency MedicineKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
| | - Chi‐Wei Chen
- Department of Emergency MedicineKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
- Graduate Institute of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
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5
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Andrea L, Rahmanian M, Bangar M, Shiloh AL, Balakrishnan R, Soleiman A, Carlese A, Gong MN, Moskowitz A. Pericardiocentesis, Chest Tube Insertion, and Needle Thoracostomy During Resuscitation of Nontraumatic Adult In-Hospital Cardiac Arrest: A Retrospective Cohort Study. Crit Care Explor 2024; 6:e1130. [PMID: 39132988 PMCID: PMC11321751 DOI: 10.1097/cce.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
IMPORTANCE In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the postresuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover IHCA study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort. OBJECTIVES Our study collects granular data on post-IHCA treatment practices, focusing on temperature control and prognostication, with the objective of describing variation in current post-IHCA practices. DESIGN, SETTING, AND PARTICIPANTS This is a multicenter, prospectively collected, observational cohort study of patients who have suffered IHCA and have been successfully resuscitated (achieved ROSC). There are 24 enrolling hospital systems (23 in the United States) with 69 individuals enrolling in hospitals (39 in the United States). We developed a standardized data dictionary, and data collection began in October 2023, with a projected 1000 total enrollments. Discover IHCA is endorsed by the Society of Critical Care Medicine. MAIN OUTCOMES AND MEASURES The study collects data on patient characteristics, including prearrest frailty, arrest characteristics, and detailed information on postarrest practices and outcomes. Data collection on post-IHCA practice was structured around current American Heart Association and European Resuscitation Council guidelines. Among other data elements, the study captures postarrest temperature control interventions and postarrest prognostication methods. RESULTS The majority of participating hospital systems are large, academic, tertiary care centers serving urban populations. The analysis will evaluate variations in practice and their association with mortality and neurologic function. CONCLUSIONS AND RELEVANCE We expect this study, Discover IHCA, to identify variability in practice and outcomes following IHCA and be a vital resource for future investigations into best practices for managing patients after IHCA.
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Affiliation(s)
- Luke Andrea
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Marjan Rahmanian
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Maneesha Bangar
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Ariel L. Shiloh
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Rithvik Balakrishnan
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Aron Soleiman
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Anthony Carlese
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Michelle N. Gong
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Ari Moskowitz
- All authors: Department of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
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6
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Gutierrez-Gallegos P, Jimenez-Franco V, Jerjes-Sanchez C, Quevedo-Salazar R, Rodriguez-Rivera J, Paredes-Gutierrez E, Lira-Lozano D, Quintanilla-Gutierrez J, Gomez-Gutierrez R, de la Peña-Almaguer E, Torre-Amione G. Successful pharmaco-invasive approach using a lower alteplase dose and VA-ECMO support in high-risk pulmonary embolism: case report. Front Cardiovasc Med 2024; 11:1444636. [PMID: 39105076 PMCID: PMC11298445 DOI: 10.3389/fcvm.2024.1444636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/10/2024] [Indexed: 08/07/2024] Open
Abstract
Despite the elevated mortality rates associated with high-risk pulmonary embolism (PE), this condition remains understudied. Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial. Here, we present the case of a 61-year-old male with high-risk PE associated with refractory cardiac arrest and cardiogenic shock who underwent a combination of extracorporeal cardiopulmonary resuscitation with VA-ECMO and pharmaco-invasive therapy (mechanical thrombi fragmentation plus lower alteplase dose), resulting in successful pulmonary reperfusion. After a prolonged in-hospital stay, the patient was discharged in stable condition.
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Affiliation(s)
| | - Vicente Jimenez-Franco
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
- Shock Team, Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
| | - Carlos Jerjes-Sanchez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
| | | | | | | | - Daniel Lira-Lozano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
| | - Juan Quintanilla-Gutierrez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
- Shock Team, Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
| | - Rene Gomez-Gutierrez
- Shock Team, Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
| | - Erasmo de la Peña-Almaguer
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
- Shock Team, Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
| | - Guillermo Torre-Amione
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
- Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
- Shock Team, Instituto de Cardiología y Medicina Vascular, TecSalud, San Pedro Garza Garcia, Mexico
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7
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Zaki HA, Iftikhar H, Shaban EE, Najam M, Alkahlout BH, Shallik N, Elnabawy W, Basharat K, Azad AM. The role of point-of-care ultrasound (POCUS) imaging in clinical outcomes during cardiac arrest: a systematic review. Ultrasound J 2024; 16:4. [PMID: 38265564 PMCID: PMC10808079 DOI: 10.1186/s13089-023-00346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/07/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cardiac arrest in hospital and out-of-hospital settings is associated with high mortality rates. Therefore, a bedside test that can predict resuscitation outcomes of cardiac arrest patients is of great value. Point-of-care ultrasound (POCUS) has the potential to be used as an effective diagnostic and prognostic tool during cardiac arrest, particularly in observing the presence or absence of cardiac activity. However, it is highly susceptible to "self-fulfilling prophecy" and is associated with prolonged cardiopulmonary resuscitation (CPR), which negatively impacts the survival rates of cardiac arrest patients. As a result, the current systematic review was created to assess the role of POCUS in predicting the clinical outcomes associated with out-of-hospital and in-hospital cardiac arrests. METHODS The search for scientific articles related to our study was done either through an electronic database search (i.e., PubMed, Medline, ScienceDirect, Embase, and Google Scholar) or manually going through the reference list of the relevant articles. A quality appraisal was also carried out with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2), and the prognostic test performance (sensitivity and sensitivity) was tabulated. RESULTS The search criteria yielded 3984 articles related to our topic, of which only 22 were eligible for inclusion. After reviewing the literature, we noticed a wide variation in the definition of cardiac activity, and the statistical heterogeneity was high; therefore, we could not carry out meta-analyses. The tabulated clinical outcomes based on initial cardiac rhythm and definitions of cardiac activity showed highly inconsistent results. CONCLUSION POCUS has the potential to provide valuable information on the management of cardiac arrest patients; however, it should not be used as the sole predictor for the termination of resuscitation efforts.
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Affiliation(s)
- Hany A Zaki
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Haris Iftikhar
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar.
| | - Eman E Shaban
- Cardiology, Al Jufairi Diagnosis and Treatment, Doha, Qatar
| | - Mavia Najam
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Nabil Shallik
- Anesthesia Department, IT Deputy Chair, HMC, Doha, Qatar
| | - Wael Elnabawy
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Kaleem Basharat
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
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8
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Millington SJ, Arntfield RT, Koenig SJ, Mayo PH, Vieillard-Baron A. Ten Influential Point-of-Care Ultrasound Papers: 2022 in Review. J Intensive Care Med 2023; 38:566-570. [PMID: 36972500 DOI: 10.1177/08850666231166898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Keeping up with the latest developments in the point-of-care ultrasound (POCUS) literature is challenging, as with any area of medicine. Our group of POCUS experts has selected 10 influential papers from the past 12 months and provided a short summary of each. We hope to provide emergency physicians, intensivists, and other acute care providers with a succinct update concerning some key areas of ultrasound interest.
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Affiliation(s)
- Scott J Millington
- Critical Care Medicine, University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Seth J Koenig
- Critical Care Medicine, Kent Hospital, Warwick, RI, USA
| | - Paul H Mayo
- Critical Care Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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9
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Riendeau Beaulac G, Teran F, Lecluyse V, Costescu A, Belliveau M, Desjardins G, Denault A. Transesophageal Echocardiography in Patients in Cardiac Arrest: The Heart and Beyond. Can J Cardiol 2023; 39:458-473. [PMID: 36621564 DOI: 10.1016/j.cjca.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
Point of care ultrasound involves different ultrasound modalities and is useful to assist management in emergent clinical situations such as cardiac arrest. The use of point of care ultrasound in cardiac arrest has mainly been described using transthoracic echocardiography as a diagnostic and as a prognostic tool. However, cardiac evaluation using transthoracic echocardiography might be challenging because of patient-related or technical factors. Furthermore, its use during pulse check pauses has been associated with delays in chest compression resumption. Transesophageal echocardiography (TEE) overcomes these limitations by providing reliable and continuous imaging of the heart without interfering with cardiopulmonary resuscitation. In this narrative review we describe the role of TEE during cardiopulmonary resuscitation in 4 different applications: (1) chest compression quality feedback; (2) rhythm characterization; (3) diagnosis of reversible causes; and (4) procedural guidance. Considering its limitations, we propose an algorithm for the integration of TEE in patients with cardiac arrest with a focus on these 4 applications and extend its use to extracardiac applications.
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Affiliation(s)
- Geneviève Riendeau Beaulac
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Felipe Teran
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Vincent Lecluyse
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Adrian Costescu
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Belliveau
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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10
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AKGÜL A. The use of ultrasonography to guide diagnosis and treatment in resuscitation in a case of arrest due to pulmonary embolism. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1069084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pulmonary embolism is one of the reversible causes of death. Simultaneous diagnostic procedures are beneficial for successfully resuscitating patients brought to the emergency department as an arrest after pulmonary embolism. Ultrasonography is one of the few diagnostic procedures to be performed on an unstable patient during resuscitation and is a direct guide for treatment. We followed the passage of the thrombus from the inferior vena cava to the right atrium in the ultrasonography performed simultaneously with the resuscitation of the 76-year-old male patient who was brought to the hospital with arrest, and we started thrombolytic therapy simultaneously with resuscitation. Thrombus enlargement was observed in the right atrium. The patient who did not respond to resuscitation died. Although the causes of reversible arrest are known, there may be uncertainties in diagnostic procedures and treatment during resuscitation. Classical resuscitation practice may be insufficient to solve reversible problems such as pulmonary embolism. Although there are reservations about the inclusion of point-of-care ultrasound in resuscitation, it can play a life-saving role.
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11
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Lau V, Blaszak M, Lam J, German M, Myslik F. Point-of-Care Resuscitative Echocardiography Diagnosis of Intracardiac Thrombus during cardiac arrest (PREDICT Study): A retrospective, observational cohort study. Resusc Plus 2022; 10:100218. [PMID: 35299826 PMCID: PMC8921470 DOI: 10.1016/j.resplu.2022.100218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) has been previously studied in cardiac arrest, without definitive markers for futile resuscitation efforts identified. Intracardiac thrombus during cardiac arrest has not been systematically studied. Our objective was to describe the incidence of intracardiac thrombus and spontaneous echo contrast found during cardiac arrest. Methods A two hospital, retrospective, observational cohort study of 56 cardiac arrest patients who were assessed with POCUS (between January 1st, 2017 to April 30th, 2020). Eligible studies were reviewed for echocardiographic findings (e.g. presence of intracardiac thrombus or spontaneous echo contrast), baseline patient demographics, cardiac arrest-related data, and clinical outcomes. Primary outcome was in-hospital mortality. Results Fifty-six intra-arrest POCUS echocardiograms were identified (out of 738 out-of-hospital cardiac arrests). The median patient age was 63 years (interquartile range [IQR]: 51–72), with 25% female patients, and median Charlson Comorbidity Index score of 4 (IQR: 2–6). The incidence of intracardiac thrombus was 21 out of 56 patients (38%). Time-to-new thrombus formation during cardiac arrest was approximately 6 minutes (IQR: 2-–8). All patients with intracardiac thrombus during cardiac arrest had termination of resuscitation. Conclusions Intracardiac thrombus is potentially common during out-of-hospital cardiac arrests and was observed more frequently in those in whom termination of resuscitation was recommended. However, this is only hypothesis-generating at this time, and further study is required to determine if the presence of intracardiac thrombus may be used as a potential marker of resuscitation futility.
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12
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The Parasternal Long Axis View in Isolation: Is it Good Enough? J Emerg Med 2022; 62:769-774. [PMID: 35562250 DOI: 10.1016/j.jemermed.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/31/2022] [Accepted: 02/25/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Focused cardiac ultrasound (FOCUS) is a vital tool to evaluate patients at the bedside, but its use can be limited by patient habitus, sonographer skill, and time to perform the examination. OBJECTIVE Our primary goal was to determine the diagnostic accuracy of the parasternal long axis (PSLA) view in isolation for identifying pericardial effusion, left ventricular (LV) dysfunction, and right ventricular (RV) dilatation compared with a four-view FOCUS examination. METHODS This was a retrospective study looking at FOCUS images. Examinations were blinded and randomized for review by point-of-care ultrasound faculty. The primary objective was measured by comparing ultrasound findings on PSLA view in isolation with findings on a full four-view FOCUS examination, which served as the criterion standard. Sensitivity and specificity were calculated. RESULTS Of 100 FOCUS examinations; 36% were normal, 16% had a pericardial effusion, 41% had an LV ejection fraction < 50%, and 7% had RV dilatation. Sensitivity and specificity for identifying pericardial effusion, LV dysfunction, and RV dilatation were 81% (confidence interval [CI] 0.54-0.95) and 98% (95% CI 0.91-0.99), 100% (95% CI 0.88-1) and 91% (95% CI 0.80-0.97), and 71% (95% CI 0.30-0.94) and 99% (95% CI 0.93-1), respectively. All moderate to large effusions were identified correctly. Overall, there were only four clinically significant disagreements between PSLA alone and the four-view interpretations. CONCLUSIONS In isolation, the PSLA view was highly sensitive and specific for identifying LV ejection fraction and moderate to large pericardial effusions. It was highly specific for identifying RV dilatation, but had only moderate sensitivity.
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Lau YH, See KC. Point-of-care ultrasound for critically-ill patients: A mini-review of key diagnostic features and protocols. World J Crit Care Med 2022; 11:70-84. [PMID: 35433316 PMCID: PMC8968483 DOI: 10.5492/wjccm.v11.i2.70] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) for managing critically ill patients is increasingly performed by intensivists or emergency physicians. Results of needs surveys among intensivists reveal emphasis on basic cardiac, lung and abdominal ultrasound, which are the commonest POCUS modalities in the intensive care unit. We therefore aim to describe the key diagnostic features of basic cardiac, lung and abdominal ultrasound as practised by intensivists or emergency physicians in terms of accuracy (sensitivity, specificity), clinical utility and limitations. We also aim to explore POCUS protocols that integrate basic cardiac, lung and abdominal ultrasound, and highlight areas for future research.
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Affiliation(s)
- Yie Hui Lau
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Kay Choong See
- Division of Respiratory & Critical Care Medicine, National University Hospital, Singapore 119074, Singapore
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Strony R, Slimmer K, Slimmer S, Corros P, Davis R, Zhu B, Niedzwiecki K, Cho D, Lapczynski J, Jia S, Lopez R, Schoenwetter D. Helicopter Emergency Medical Services Performed Extended Focused Assessment With Sonography: Training, Workflow, and Sustainable Quality. Air Med J 2022; 41:209-216. [PMID: 35307145 DOI: 10.1016/j.amj.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
The extended focused assessment of trauma (EFAST) examination is an invaluable tool for the initial evaluation of the trauma patient. Miniaturization of ultrasound has enabled helicopter emergency medical services (HEMS) to use point-of-care ultrasound to care for trauma patients on scene. Our study demonstrated that HEMS crews accurately performed EFAST examinations after the implementation of a novel HEMS EFAST workflow, multifaceted training, and ongoing quality assurance. The HEMS crews' overall sensitivity was 53%, and specificity was 98%. The obtained image quality was highest for the lung, cardiac, and right upper quadrant components of the EFAST. Our results suggest that with a structured multifaceted training program, user-friendly workflow, and ongoing quality assurance, HEMS crews can perform EFAST examinations safely and reliably in the field. This would allow HEMS crews to detect life-threatening, time-sensitive conditions such as a pneumothorax, pericardial effusion, and intraperitoneal hemorrhage. HEMS EFAST has the potential to triage certain trauma patients directly to the operating room or newly emerging hybrid suites, bypassing the emergency room and saving crucial time.
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Affiliation(s)
- Robert Strony
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA.
| | | | - Samuel Slimmer
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA
| | - Pete Corros
- Geisinger Medical Center, Life Flight, Danville, PA
| | - Richard Davis
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA
| | - Bo Zhu
- Department of Emergency Medicine, Geisinger Wyoming Valley, Wilkes Barre, PA
| | | | - Davis Cho
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - John Lapczynski
- Department of Emergency Medicine, Anne Arundel Medical Center, Baltimore, MD
| | - Sharon Jia
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA
| | - Richard Lopez
- Geisinger Wyoming Valley, Department of Trauma Surgery, Willkes Barre, PA
| | - David Schoenwetter
- Department of Emergency Medicine, Geisinger Wyoming Valley, Wilkes Barre, PA
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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.
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Olszynski P, Marshall RA, Olver TD, Oleniuk T, Auser C, Wilson T, Atkinson P, Woods R. Performance of an automated ultrasound device in identifying and tracing the heart in porcine cardiac arrest. Ultrasound J 2022; 14:1. [PMID: 34978635 PMCID: PMC8724362 DOI: 10.1186/s13089-021-00251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While intra-arrest echocardiography can be used to guide and monitor chest compression quality, it is not currently feasible on the scene of out-of-hospital cardiac arrests. Rapid and automated sonographic localization of the heart may provide first-responders guidance to an optimal area of compression without requiring them to interpret ultrasound images. In this proof-of-concept porcine study, we sought to describe the performance of an automated ultrasound device in correctly identifying and tracing the borders of the heart in three distinct states: pre-arrest, arrest, and late arrest. METHODS An automated ultrasound device (bladder scanner) was placed on the chests of 7 swine, along the left sternal border (4th-8th intercostal spaces). Scanner-generated images were recorded for each space during pre-arrest, arrest, and finally late arrest. 828 images of the LV and LV outflow tract were randomized and 150 (50/state) selected for analysis. Scanner tracings of the heart were then digitally obscured to facilitate tracing by expert reviewers who were blinded to the physiologic state. Reviewer tracings were compared to bladder scanner tracings; with concordance between these images determined via Sørensen-Dice index (SDI). RESULTS When compared to human reviewers, the bladder scanner was able to identify and trace the borders during cardiac arrest. The bladder scanner performed best at the time of arrest (SDI 0.900 ± 0.059). As resuscitation efforts continued and time from initial arrest increased, the scanner's performance decreased dramatically (SDI 0.597 ± 0.241 in late arrest). CONCLUSION An automated ultrasound device (bladder scanner) reliably traced porcine hearts during cardiac arrest. It is possible a device could be developed to indicate where compressions should be performed without requiring the operator to interpret ultrasound images. Further investigation into rapid, automated, sonographic localization of the heart to identify the area of compression in out-of-hospital cardiac arrest is warranted.
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Affiliation(s)
- Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
| | - Rory A Marshall
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - T Dylan Olver
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Trevor Oleniuk
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Cameron Auser
- College of Arts and Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Tracy Wilson
- Department of Emergency Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie, Saint John, Canada
| | - Rob Woods
- Department of Emergency Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
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Burkule N, Bansal M, Govind S, Alagesan R, Ponde C, Parashar S. Corrected and Republished: Indian Academy of Echocardiography Guidelines for Performance of Transesophageal Echocardiography in Adults. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_54_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ávila-Reyes D, Acevedo-Cardona AO, Gómez-González JF, Echeverry-Piedrahita DR, Aguirre-Flórez M, Giraldo-Diaconeasa A. Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article. Ultrasound J 2021; 13:46. [PMID: 34855015 PMCID: PMC8639882 DOI: 10.1186/s13089-021-00248-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/12/2021] [Indexed: 12/28/2022] Open
Abstract
The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.
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Affiliation(s)
- Diana Ávila-Reyes
- Department of Critical Care Medicine, Universidad Tecnológica de Pereira, Grupo de Investigación Medicina Crítica Y Cuidados Intensivos (GIMCCI), Pereira, Colombia.
| | - Andrés O Acevedo-Cardona
- Department of Critical Care Medicine, Universidad Tecnológica de Pereira,, Pereira, Colombia
- Master en Ecocardiografía en Cuidados Intensivos, Sociedad Española de Imagen Cardíaca/Universidad Francisco de Vitoria, España, Pereira, Spain
| | - José F Gómez-González
- Department of Critical Care Medicine, Universidad Tecnológica de Pereira, Pereira, Colombia
- Grupo Investigación de Medicina Crítica Y Cuidados Intensivos (GIMCCI), Pereira, Colombia
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Echocardiography during cardiac arrest: Time to incorporate into ACLS? Resuscitation 2021; 169:173-174. [PMID: 34798180 DOI: 10.1016/j.resuscitation.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
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U SO CARE-The Impact of Cardiac Ultrasound during Cardiopulmonary Resuscitation: A Prospective Randomized Simulator-Based Trial. J Clin Med 2021; 10:jcm10225218. [PMID: 34830500 PMCID: PMC8625670 DOI: 10.3390/jcm10225218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Actual cardiopulmonary resuscitation (CPR) guidelines recommend point-of-care ultrasound (POCUS); however, data on POCUS during CPR are sparse and conflicting. This randomized trial investigated the effects of POCUS during CPR on team performance and diagnostic accuracy. METHODS Intensive Care and Emergency Medicine residents performed CPR with or without available POCUS in simulated cardiac arrests. The primary endpoint was hands-on time. Data analysis was performed using video recordings. RESULTS Hands-on time was 89% (87-91) in the POCUS and 92% (89-94) in the control group (difference 3, 95% CI for difference 2-4, p < 0.001). POCUS teams had delayed defibrillator attachments (33 vs. 26 sec, p = 0.017) and first rhythm analysis (74 vs. 52 sec, p = 0.001). Available POCUS was used in 71%. Of the POCUS teams, 3 stated a POCUS-derived diagnosis, with 49 being correct and 42 followed by a correct treatment decision. Four teams made a wrong diagnosis and two made an inappropriate treatment decision. CONCLUSIONS POCUS during CPR resulted in lower hands-on times and delayed rhythm analysis. Correct POCUS diagnoses occurred in 52%, correct treatment decisions in 44%, and inappropriate treatment decisions in 2%. Training on POCUS during CPR should focus on diagnostic accuracy and maintenance of high-quality CPR.
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21
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Kool M, Atkins DL, Van de Voorde P, Maconochie IK, Scholefield BR. Focused echocardiography, end-tidal carbon dioxide, arterial blood pressure or near-infrared spectroscopy monitoring during paediatric cardiopulmonary resuscitation: A scoping review. Resusc Plus 2021; 6:100109. [PMID: 34228034 PMCID: PMC8244529 DOI: 10.1016/j.resplu.2021.100109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
AIM To evaluate the individual use and predictive value of focused echocardiography, end-tidal carbon dioxide (EtCO2), invasive arterial blood pressure (BP) and near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR) in children. METHODS This scoping review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) and based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews. PubMed, MEDLINE, CINAHL and EMBASE were searched from the last ILCOR reviews until September 2020. We included all published studies evaluating the effect of echocardiography, EtCO2, BP or NIRS guided CPR on clinical outcomes and quality of CPR. RESULTS We identified eight observational studies, including 288 children. Two case series reported the use of echocardiography, one in detecting pulmonary emboli, the second in cardiac standstill, where contractility was regained with the use of extracorporeal membrane oxygenation. The two studies describing EtCO2 were ambivalent regarding the association between mean values and any outcomes. Mean diastolic BP was associated with increased survival and favourable neurological outcome, but not with new substantive morbidity in two studies describing an overlapping population. NIRS values reflected changes in EtCO2 and cerebral blood volume index in two studies, with lower values in patients who did not achieve return of circulation. CONCLUSION Although there seems some beneficial effect of these intra-arrest variables, higher quality paediatric studies are needed to evaluate whether echocardiography, EtCO2, BP or NIRS guided CPR could improve outcomes.
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Key Words
- Arterial blood pressure
- BP, blood pressure (invasive arterial)
- BVI, blood volume index
- CA, cardiac arrest
- CI, confidence interval
- CPR, cardiopulmonary resuscitation
- CSF, cerebrospinal fluid
- Cardiopulmonary resuscitation
- CoSTR, consensus on science with treatment recommendations
- ECG, electrocardiogram
- ECMO, extracorporeal membrane oxygenation
- ECPR, extracorporeal cardiopulmonary resuscitation
- ED, emergency department
- End-tidal CO2
- EtCO2, end-tidal carbon dioxide
- ICP, intracranial pressure
- IHCA, in-hospital cardiac arrest
- ILCOR, international liaison committee on resuscitation
- NICU, neonatal intensive care unit
- NIRS, near-infrared spectroscopy
- Near-infrared spectroscopy
- OHCA, out-of-hospital cardiac arrest
- OR, odds ratio
- PCICU, paediatric cardiac intensive care unit
- PE, pulmonary emboli
- PICU, paediatric intensive care unit
- PRISMA, preferred reporting items for systematic reviews and meta-analyses
- Paediatric life support
- Point-of-care ultrasound
- RCT, randomized controlled trial
- ROC, receiver operating characteristic
- ROSC, return of spontaneous circulation
- RR, relative risk
- RV, right ventricle
- SD, standard deviation
- USA, United States of America
- rcSO2, regional cerebral oxygen saturations
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Affiliation(s)
- Mirjam Kool
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Paediatric Intensive Care Unit, Birmingham Children’s Hospital NHS Trust, Steelhouse Lane, Birmingham, United Kingdom
| | - Dianne L. Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Patrick Van de Voorde
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
- EMS Dispatch Center Eastern Flanders, Federal Department of Health, Belgium
| | - Ian K. Maconochie
- Paediatric Emergency Department, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Barnaby R. Scholefield
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Paediatric Intensive Care Unit, Birmingham Children’s Hospital NHS Trust, Steelhouse Lane, Birmingham, United Kingdom
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Olszynski PA, Bryce R, Hussain Q, Dunn S, Blondeau B, Atkinson P, Woods R. A Novel Anatomic Landmark to Target the Left Ventricle During Chest Compressions in Cardiac Arrest. Cureus 2021; 13:e13652. [PMID: 33680627 PMCID: PMC7925053 DOI: 10.7759/cureus.13652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 12/18/2022] Open
Abstract
Background Resuscitation guidelines recommend that chest compressions be performed over the lower sternum. Current computed tomography and magnetic resonance imaging studies suggest that the current area of compression does not target the left ventricle (LV). Using transthoracic ultrasound, we sought to identify potential anatomic landmarks that would result in compressions over the LV in the majority of our study participants. Methodology We recruited 64 healthy men and women (over the age of 40) from the Simulated Patient Program at the University of Saskatchewan. Using ultrasound, we identified the LV and the associated surface anatomy in terms of intercostal space (ICS) and parasternal or mid-clavicular lines. We also collected biometric data including body mass index, chest circumference, and the corresponding inter-nipple line ICS. Results The LV was located along the left sternal border in 62 (96.9%) participants. The most frequent LV location was along the left sternal border at the sixth ICS in 26 (40.6%) participants, with 13 (20.3%) at the fifth and 10 (15.6%) participants at the seventh ICS. In two (3.1%) participants, the LV was found along the mid-clavicular zone at the fifth ICS. The area from the fifth to seventh ICS on the left sternal border, typically covered by an adult palm centered at the sixth ICS, overlaid 49 of 64 (76.6%, 95% confidence interval [CI]: 64.3-86.2%) identified LV locations. By comparison, centering the heel of the palm over the inter-nipple line at the left sternal border would cover the LV in 46 (71.9%, 95% CI: 59.2-82.4%) participants. Conclusions A novel area of compression over the left sternal border at the inter-nipple line would result in compressions over the LV in nearly three-quarters of our study participants. Future research should investigate whether this proposed area of compression is applicable to a broader population including those with cardiac and thoracic disease.
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Affiliation(s)
| | - Rhonda Bryce
- Clinical Research Support Unit, University of Saskatchewan, Saskatoon, CAN
| | - Qasim Hussain
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Stephanie Dunn
- Emergency Department, Royal University Hospital, Saskatoon, CAN
- Faculty of Nursing, University of Regina, Saskatoon, CAN
| | - Brandon Blondeau
- School of Health Sciences, Saskatchewan Polytechnic, Saskatoon, CAN
| | - Paul Atkinson
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
- Emergency Medicine, Dalhousie University, Halifax, CAN
| | - Robert Woods
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
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Olszynski PA, Bryce R, Hussain Q, Dunn S, Blondeau B, Atkinson P, Woods R. Use of a Simple Ultrasound Device to Identify the Optimal Area of Compression for Out-of-Hospital Cardiac Arrest. Cureus 2021; 13:e12785. [PMID: 33489641 PMCID: PMC7815272 DOI: 10.7759/cureus.12785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
Background Despite automated defibrillation and compression-first resuscitation, out-of-hospital cardiac arrest (OHCA) survival remains low. Resuscitation guidelines recommend that chest compressions should be done over the lower half of the sternum, but evidence indicates that this is often associated with outflow obstruction. Emerging studies suggest that compression directly over the left ventricle (LV) may improve survival and outcomes, but rapid and reliable localization of the LV is a major obstacle for those first responding to OHCA. This study aimed to determine if a simplified, easy-to-use ultrasound device (bladder scanner) can reliably locate the heart when applied over the intercostal spaces of the anterior thorax in supine patients. Furthermore, we sought to describe the association between largest scan volumes and underlying cardiac anatomy with particular attention to the long axis of the LV. Methodology We recruited healthy male and female volunteers over 40 years of age. Using a bladder scanner to evaluate the left sternal border and mid-clavicular lines, we determined the maximal scan volumes at 10 intercostal spaces for each participant. Cardiac ultrasound was then used to evaluate the corresponding underlying cardiac anatomy and determine the area overlying the long-axis view of the LV. Descriptive statistics (means with standard deviations [SD], medians with interquartile ranges, and frequencies with proportions) were used to quantify demographic information, typical scan volumes across the chest, the frequencies of the best long-axis LV view location. This was then repeated for left sternal border assessments only. Kappa was determined when evaluating agreement between the largest left sternal border scan volume and the best long-axis LV view location. Results The long-axis LV was the predominant structure underlying the largest scan volume in 39/51 (76.5%) patients. When limited to left sternal border volumes only, the long axis of the LV was underlying the maximum volume intercostal space in 46/51 (90.2%; 95% confidence interval [CI]: 78.6%, 96.7%). The largest left sternal border scan volumes were located over the best long-axis LV view in 39/51 (76.5%, 95% CI: 62.5%, 87.2%) of the study participants with a Kappa statistic of 0.68 (95% CI: 0.52, 0.84; p < 0.0001). Conclusions In this cross-sectional study of healthy volunteers, an easy-to-use ultrasound device (bladder scanner) was able to reliably localize the heart. Largest scan volumes over the left sternal border showed substantial agreement with the intercostal space overlying the long axis of the LV. Further investigations are warranted to determine if such localization is reliable in cardiac arrest patients.
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Affiliation(s)
| | - Rhonda Bryce
- Clinical Research Support Unit, University of Saskatchewan, Saskatoon, CAN
| | - Qasim Hussain
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Stephanie Dunn
- Faculty of Nursing, University of Regina, Saskatoon, CAN
| | - Brandon Blondeau
- School of Health Sciences, Saskatchewan Polytechnic, Saskatoon, CAN
| | - Paul Atkinson
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
- Emergency Medicine, Dalhousie, Halifax, CAN
| | - Robert Woods
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
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Singh MR, Jackson JS, Newberry MA, Riopelle C, Tran VH, PoSaw LL. Barriers to point-of-care ultrasound utilization during cardiac arrest in the emergency department: a regional survey of emergency physicians. Am J Emerg Med 2021; 41:28-34. [PMID: 33383268 DOI: 10.1016/j.ajem.2020.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Though point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED). METHODS Two survey instruments were distributed to emergency medicine (EM) attending and resident physicians at three academic centers in the South Florida. The surveys assessed demographics, experience, proficiency, attitudes and barriers. Descriptive and inferential statistics along with Item Response Theory Logistic Model and the Friedman Test with Wilcoxon Signed Rank tests were used to profile responses and rank barriers. RESULTS 206 EM physicians were invited to participate in the survey, and 187 (91%) responded. 59% of attending physicians and 47% of resident physicians reported that POCUS is performed in all their cases of CA. 5% of attending physicians and 0% of resident physicians reported never performing POCUS during CA. The top-ranked departmental barrier for attending physicians was "No structured curriculum to educate physicians on POCUS." The top-ranked personal barriers were "I do not feel comfortable with my POCUS skills" and "I do not have sufficient time to dedicate to learning POCUS." The top-ranked barriers for resident physicians were "Time to retrieve and operate the machine" and "Chaotic milieu." CONCLUSIONS While our study demonstrates that most attending and resident physicians utilize POCUS in CA, barriers to high-quality implementation exist. Top attending physician barriers relate to POCUS education, while the top resident physician barriers relate to logistics and the machines. Interventions to overcome these barriers might lead to optimization of POCUS performance during CA in the ED.
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Affiliation(s)
- Mallika R Singh
- University of Miami Miller School of Medicine, Miami, FL, United States of America.
| | - Jennifer S Jackson
- University of Miami Miller School of Medicine, Miami, FL, United States of America; Holy Cross Hospital, Ft. Lauderdale, FL, United States of America.
| | - Mark A Newberry
- Mt. Sinai Medical Center, Miami Beach, FL, United States of America.
| | - Cameron Riopelle
- University of Miami Miller School of Medicine, Miami, FL, United States of America; University of Miami Libraries, University of Miami.
| | - Vu Huy Tran
- Aventura Hospital & Medical Center, Aventura, FL, United States of America.
| | - Leila L PoSaw
- Jackson Memorial Hospital, Miami, FL, United States of America.
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Melton MS, Li YJ, Pollard R, Chen Z, Hunting J, Hopkins T, Buhrman W, Taicher B, Aronson S, Stafford-Smith M, Raghunathan K. Unplanned hospital admission after ambulatory surgery: a retrospective, single cohort study. Can J Anaesth 2021. [PMID: 33058058 DOI: 10.1007/s12630-020-01822-1/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
PURPOSE We estimated the rate of unplanned hospital and intensive care unit (ICU) admissions following ambulatory surgery centre (ASC) procedures, and identified factors associated with their occurrence. METHODS This retrospective cohort included adult patients who underwent ASC procedures within a large community practice from January 2010 to December 2014. Patients were categorized into two groups: unplanned postoperative hospital/ICU admission within 24 hr of procedure or uneventful discharge. Demographics, comorbidities, anesthesia type, procedure type, procedure group, and ASC facility were assessed. RESULTS Of the 211,389 patients included, there were 211,147 uneventful discharges (99.89%) and 242 unplanned hospital admissions (0.11%), of which 75 were ICU admissions (0.04%). The multivariable logistic regression model for hospital admission showed an increased risk associated with age > 50 yr (odds ratio [OR], 1.53); American Society of Anesthesiologists (ASA) physical status (III vs II: OR, 1.45; IV vs II: OR, 1.88), comorbidity (chronic obstructive pulmonary disease: OR, 2.63; diabetes mellitus: OR, 1.62; transient ischemic attack: OR, 2.48) procedure (respiratory: OR, 2.92; digestive: OR, 2.66; musculoskeletal system: OR, 2.53), anesthetic management (general anesthesia [GA] and peripheral nerve block vs GA: OR, 1.79), and ASC facility (189BB: OR, 2.29; 30E9A: OR, 7.41; and BD21F: OR, 1.69). The multivariable logistic regression model for ICU admission showed increased risk of unplanned ICU admission associated with ASA physical status (ASA III vs II: OR, 3.0; ASA IV vs II: OR, 8.52), procedure (musculoskeletal system: OR, 2.45), and ASC facility (00E6C: OR, 3.14; 189BB: OR, 2.77; 30E9A: OR, 2.59; and BD21F: OR, 3.71). CONCLUSION While a small percentage of adult patients who underwent ASC procedures required unplanned hospital admission (0.07%), approximately one-third of these admissions were to the ICU (0.04%). Facility was at least as strong a predictor of hospital admission as the patient- and/or procedure-specific variables.
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Affiliation(s)
- M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA.
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | | | - Zhengxi Chen
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - John Hunting
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Thomas Hopkins
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - William Buhrman
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Brad Taicher
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Solomon Aronson
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
- CAPER Unit, Duke Anesthesiology, Durham, NC, USA
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Melton MS, Li YJ, Pollard R, Chen Z, Hunting J, Hopkins T, Buhrman W, Taicher B, Aronson S, Stafford-Smith M, Raghunathan K. Unplanned hospital admission after ambulatory surgery: a retrospective, single cohort study. Can J Anaesth 2021; 68:30-41. [PMID: 33058058 DOI: 10.1007/s12630-020-01822-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE We estimated the rate of unplanned hospital and intensive care unit (ICU) admissions following ambulatory surgery centre (ASC) procedures, and identified factors associated with their occurrence. METHODS This retrospective cohort included adult patients who underwent ASC procedures within a large community practice from January 2010 to December 2014. Patients were categorized into two groups: unplanned postoperative hospital/ICU admission within 24 hr of procedure or uneventful discharge. Demographics, comorbidities, anesthesia type, procedure type, procedure group, and ASC facility were assessed. RESULTS Of the 211,389 patients included, there were 211,147 uneventful discharges (99.89%) and 242 unplanned hospital admissions (0.11%), of which 75 were ICU admissions (0.04%). The multivariable logistic regression model for hospital admission showed an increased risk associated with age > 50 yr (odds ratio [OR], 1.53); American Society of Anesthesiologists (ASA) physical status (III vs II: OR, 1.45; IV vs II: OR, 1.88), comorbidity (chronic obstructive pulmonary disease: OR, 2.63; diabetes mellitus: OR, 1.62; transient ischemic attack: OR, 2.48) procedure (respiratory: OR, 2.92; digestive: OR, 2.66; musculoskeletal system: OR, 2.53), anesthetic management (general anesthesia [GA] and peripheral nerve block vs GA: OR, 1.79), and ASC facility (189BB: OR, 2.29; 30E9A: OR, 7.41; and BD21F: OR, 1.69). The multivariable logistic regression model for ICU admission showed increased risk of unplanned ICU admission associated with ASA physical status (ASA III vs II: OR, 3.0; ASA IV vs II: OR, 8.52), procedure (musculoskeletal system: OR, 2.45), and ASC facility (00E6C: OR, 3.14; 189BB: OR, 2.77; 30E9A: OR, 2.59; and BD21F: OR, 3.71). CONCLUSION While a small percentage of adult patients who underwent ASC procedures required unplanned hospital admission (0.07%), approximately one-third of these admissions were to the ICU (0.04%). Facility was at least as strong a predictor of hospital admission as the patient- and/or procedure-specific variables.
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Affiliation(s)
- M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA.
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | | | - Zhengxi Chen
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - John Hunting
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Thomas Hopkins
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - William Buhrman
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Brad Taicher
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Solomon Aronson
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, DUMC, Box #3094, Stop# 4, Durham, NC, 27110, USA
- CAPER Unit, Duke Anesthesiology, Durham, NC, USA
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Burkule N, Bansal M, Govind S, Alagesan R, Ponde C, Parashar S. Indian Academy of Echocardiography Guidelines for Performance of Transesophageal Echocardiography in Adults. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2021. [DOI: 10.4103/jiae.jiae_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Devia Jaramillo G, Navarrete Aldana N, Rojas Ortiz Z. Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia. Int J Emerg Med 2020; 13:62. [PMID: 33276729 PMCID: PMC7716448 DOI: 10.1186/s12245-020-00319-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/21/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. OBJECTIVE This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. MATERIALS AND METHODS This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. RESULTS Of a total of 108 patients, the median of the age was 71 years, 65.8% were male subjects, and the most frequent cause for cardiac arrest was the cardiogenic shock (32.4%). ROSC was observed in 41 cases (37.9%) and survival at discharge was 18 cases (16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. CONCLUSION There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.
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Affiliation(s)
- German Devia Jaramillo
- Department of Emergency Medicine, Universidad del Rosario, Bogotá, Colombia.
- Hospital Universitario Mayor Méderi, Bogotá, Colombia.
| | | | - Zaira Rojas Ortiz
- Department of Emergency Medicine, Universidad del Rosario, Bogotá, Colombia
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Taylor B, Joshi B, Hutchison L, Manivel V. Echocardiography does not prolong peri-shock pause in cardiopulmonary resuscitation using the COACH-RED protocol with non-expert sonographers in simulated cardiac arrest. Resusc Plus 2020; 4:100047. [PMID: 34223322 PMCID: PMC8244492 DOI: 10.1016/j.resplu.2020.100047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Focused echocardiography during peri-shock pause (PSP) can prognosticate and detect reversible causes in cardiac arrest but minimising interruptions to chest compressions improves outcome. The COACH-RED protocol was adapted from the COACHED protocol to systematically incorporate echocardiography into rhythm check without prolonging PSP beyond the recommended 10 s. The primary objective of this study was to test the feasibility of emergency nurses learning to perform all roles in the COACH-RED protocol. PSP duration and change in participant confidence were secondary outcomes. METHODS After an initial two-hour workshop, five ALS-trained nurses were assessed for the correct use of COACH-RED protocol, without critical error, in three simulated cardiac arrest scenarios of four cycles each. Assessments were repeated on days 7 and 35. On day 35, three COACHED scenarios were also assessed for comparison. Participant roles per scenario and cardiac rhythm per cycle were randomised. Participants completed questionnaires on their confidence levels. Sessions were videotaped for accurate measurement of PSP duration and results tabulated for simple comparison. Statistical analysis was not performed due to small sample size. RESULTS There were no critical errors, two minor team-leading errors and two minor echosonography errors. Minor errors occurred in separate scenarios resulting in a 100% pass rate overall by predetermined criteria. Echocardiographic recordings were 100% adequate. Overall median PSP was 9.35 s for COACH-RED and 6.94 s for COACHED. Sub-group analysis of COACH-RED revealed median PSP 10.80 s in shockable rhythms and 8.74 s (∼2 s less) in non-shockable rhythms. Mean participant confidence in performing COACH-RED improved from 1.6 to 4.6, on a 5-point scale. CONCLUSION The COACH-RED protocol can be effectively performed by ALS-trained nurses, in all roles of this protocol, including echocardiography, in a simulated environment, after a single training session. Using this protocol, focused echocardiography does not prolong PSP beyond 10 s.
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Key Words
- ALS, Advanced Life Support
- ARC, Australian Resuscitation Council
- Advanced cardiac life support
- CPR, Cardiopulmonary resuscitation
- Cardiac arrest
- Cardiopulmonary resuscitation
- ED, Emergency Department
- Echocardiography
- Education
- IQR, Interquartile Range
- Nursing
- PEA, Pulseless Electrical Activity
- PSP, Peri-Shock Pause
- SAH, Sydney Adventist Hospital
- Simulation training
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
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Affiliation(s)
- Benjamin Taylor
- Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
| | - Bhushan Joshi
- Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
| | - Leanne Hutchison
- Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
| | - Vijay Manivel
- Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
- The University of Sydney, Sydney, NSW 2000, Australia
- Emergency Department, Nepean Hospital, Kingswood, NSW 2747, Australia
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Transesophageal echocardiography in patients with cardiac arrest: from high-quality chest compression to effective resuscitation. J Echocardiogr 2020; 19:28-36. [PMID: 33245547 DOI: 10.1007/s12574-020-00492-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 08/11/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Survival after cardiac arrest depends on prompt and effective cardiopulmonary resuscitation (CPR). Transesophageal echocardiography (TEE) can be applied to evaluate the effectiveness of chest compression-decompression maneuvers in the setting of cardiac arrest undergoing CPR. The efficacy of chest compression can be continuously assessed by TEE that can improve the effectiveness of CPR guiding the rescuer to optimize or correct chest compression and decompression by directly examining the movements of the cardiac walls and valve leaflets. PURPOSE The review describes how to perform TEE in the emergency setting of cardiopulmonary arrest, its advantages, and limitations, and ultimately propose an echo-guided approach to CPR.
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Tanimoto A, Sugiyama K, Tanabe M, Kitagawa K, Kawakami A, Hamabe Y. Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study. Scand J Trauma Resusc Emerg Med 2020; 28:101. [PMID: 33054829 PMCID: PMC7559626 DOI: 10.1186/s13049-020-00800-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p = 0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p = 0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.
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Affiliation(s)
- Atsunori Tanimoto
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan.
| | - Maki Tanabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kanta Kitagawa
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
| | - Ayumi Kawakami
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 23-15 Kohtohbashi, 4-Chome, Sumida-ku, Tokyo, 130-8575, Japan
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Point-of-care cardiac ultrasound during cardiac arrest: a reliable tool for termination of resuscitation? Curr Opin Crit Care 2020; 26:603-611. [PMID: 33002970 DOI: 10.1097/mcc.0000000000000766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Point-of-care ultrasound (POCUS) is commonly used during cardiac arrest to screen for potential causes and to inform termination of resuscitation. However, unique biases and limitations in diagnostic and prognostic test accuracy studies lead to potential for misinterpretation. The present review highlights recent evidence regarding POCUS in cardiac arrest, guides the incorporation of POCUS into clinical management, and outlines how to improve the certainty of evidence. RECENT FINDINGS Multiple frameworks organize and direct POCUS during cardiac arrest. Although many are proofs of concept, several have been prospectively evaluated. Indirect evidence from undifferentiated shock suggests that POCUS offers better specificity than sensitivity as a diagnostic aid. The prognostic accuracy of POCUS during cardiac arrest to predict subsequent clinical outcomes is better characterized, but subject to unique biases and confounding. Low certainty direct evidence suggests that POCUS offers better specificity than sensitivity as a prognostic aid. SUMMARY POCUS findings might indicate a particular diagnosis or encourage the continuation of resuscitation, but absence of the same is not sufficient in isolation to exclude a particular diagnosis or cease resuscitation. Until the evidence to support POCUS during cardiac arrest is more certain, it is best characterized as a diagnostic and prognostic adjunct.
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Jolobe OMP. Important caveats in refractory cardiac arrest. Am J Emerg Med 2020; 46:676-677. [PMID: 32829993 DOI: 10.1016/j.ajem.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Oscar M P Jolobe
- Medical Division, Manchester Medical Society, Simon Building, Brunswick Street, Manchester, M13 9PL, UK.
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Duncan PGA, Mackey J. Point-of-care ultrasound at Role 1: is it time for a rethink? BMJ Mil Health 2020; 166:406-410. [DOI: 10.1136/bmjmilitary-2020-001466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/04/2022]
Abstract
IntroductionThe past 20 years have seen a rapid increase in point-of-care ultrasound (POCUS) use in the prehospital sphere. However, in the British Army there is no POCUS capability in the Defence Primary Healthcare (DPHC) or deployed Role 1 setting. POCUS can improve diagnostic capability, influence management decisions and transfer destination, and is a useful triage tool in mass casualty management.MethodA survey on POCUS use was sent to 279 clinicians working in the Role 1, civilian prehospital and Defence Primary Healthcare environments. Questions explored current levels of experience and training, indications for use and attitudes towards roll out. Results were analysed using a mixed methods approach.ResultsThere were 124 respondents (279 recipients; 44.4% response rate). 74.2% (92 respondents) had no experience of using POCUS while 9.7% (12 respondents) were classed as frequent users. The four most common indications for prehospital POCUS were abdominal, cardiac and lung imaging and vascular access. The majority of respondents felt that POCUS would add value in the deployed Role 1 environment; this was even more evident in the frequent user group. Common concerns were difficulty maintaining currency, governance burden and uncertainty over impact on management.ConclusionThe majority of doctors surveyed feel that POCUS would add value at Role 1 and is a capability that should be developed. The authors will watch with interest the progress of Project MORPHO.
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Rublee C, Yang B, Eisinger G, Slivnick J, Obarski T, Bahner D, Li-Sauerwine S. A Case for the Use of Transesophageal Echocardiography in the ED Treatment of Cardiac Arrest. Chest 2020; 157:e173-e176. [PMID: 32386652 DOI: 10.1016/j.chest.2019.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/10/2019] [Indexed: 10/24/2022] Open
Affiliation(s)
- Caitlin Rublee
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| | - Betty Yang
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| | - Gregory Eisinger
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| | - Jeremy Slivnick
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| | - Timothy Obarski
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| | - David Bahner
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| | - Simiao Li-Sauerwine
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH.
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Reynolds JC, Issa MS, C Nicholson T, Drennan IR, Berg KM, O'Neil BJ, Welsford M. Prognostication with point-of-care echocardiography during cardiac arrest: A systematic review. Resuscitation 2020; 152:56-68. [PMID: 32437781 DOI: 10.1016/j.resuscitation.2020.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 11/19/2022]
Abstract
AIM To conduct a prognostic factor systematic review on point-of-care echocardiography during cardiac arrest to predict clinical outcomes in adults with non-traumatic cardiac arrest in any setting. METHODS We conducted this review per PRISMA guidelines and registered with PROSPERO (ID pending). We searched Medline, EMBASE, Web of Science, CINAHL, and the Cochrane Library on September 6, 2019. Two investigators screened titles and abstracts, extracted data, and assessed risks of bias using the Quality in Prognosis Studies (QUIPS) template. We estimated prognostic test performance (sensitivity and specificity) and measures of association (odds ratio). Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology evaluated the certainty of evidence. RESULTS In total, 15 studies were included. We found wide variation across studies in the definition of 'cardiac motion' and timing of sonographic assessment. Most studies were hindered by high risks of bias from prognostic factor measurement, outcome measurement, and lack of adjustment for other prognostic factors. Ultimately, heterogeneity and risk of bias precluded meta-analyses. We tabulated ranges of prognostic test performance and measures of association for 5 different combinations of definitions of 'cardiac motion' and sonographic timing, as well as other miscellaneous sonographic findings. Overall certainty of this evidence is very low. CONCLUSIONS The evidence for using point-of-care echocardiography as a prognostic tool for clinical outcomes during cardiac arrest is of very low certainty and is hampered by multiple risks of bias. No sonographic finding had sufficient and/or consistent sensitivity for any clinical outcome to be used as sole criterion to terminate resuscitation.
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Affiliation(s)
- Joshua C Reynolds
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States.
| | - Mahmoud S Issa
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Tonia C Nicholson
- Department of Emergency Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Ian R Drennan
- Li Ka Shing Knowledge Institute, University of Toronto Institute of Medical Science, Toronto, Ontario, Canada
| | - Katherine M Berg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, United States
| | - Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Jolobe OMP. Transthoracic echocardiography is a noninvasive alternative to TEE. Am J Emerg Med 2020; 38:828-829. [PMID: 32081550 DOI: 10.1016/j.ajem.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022] Open
Affiliation(s)
- Oscar M P Jolobe
- Medical Division, Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, United Kingdom.
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Ultrasound Should Not be Routinely Used During Cardiopulmonary Resuscitation for Shockable Rhythms. Ann Emerg Med 2020; 75:515-517. [PMID: 32216881 DOI: 10.1016/j.annemergmed.2019.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Indexed: 11/20/2022]
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de Gregorio C, Stanzione A. Cardiac Thrombus Formation During Cardiopulmonary Resuscitation for Cardiac Arrest: Is It Time for Ultrasound-Enhanced Algorithms? J Cardiovasc Echogr 2020; 29:169-171. [PMID: 32089997 PMCID: PMC7011489 DOI: 10.4103/jcecho.jcecho_16_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Current guidelines consider thrombosis as a potential (and reversible) cause of cardiorespiratory arrest (CA). However, cardiac thrombus formation (TF) is likely to be the consequence of the forward blood flow ceasing during cardiac standstill. We present the case of a young man who was hospitalized for infective endocarditis, complicated by multiorgan disease and sudden CA on the 5th day. Prompt cardiopulmonary resuscitation (CPR) warranted a return of spontaneous circulation in 16 min but, unexpectedly, a TF was recognized in the right atrium at echocardiography. The blood clot resolved with rapid administration of endovenous heparin and continued chest compressions. Even though cardiac ultrasound is not ready for a routine use during CPR, the present study confirms a key role in the management of CA patients.
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Affiliation(s)
- Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Cardiology Unit, Postgraduate Residency School on Cardiovascular Diseases, University Hospital G. Martino, Messina, Italy
| | - Alessio Stanzione
- Department of Clinical and Experimental Medicine, Cardiology Unit, Postgraduate Residency School on Cardiovascular Diseases, University Hospital G. Martino, Messina, Italy
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Kedan I, Ciozda W, Palatinus JA, Palatinus HN, Kimchi A. Prognostic value of point-of-care ultrasound during cardiac arrest: a systematic review. Cardiovasc Ultrasound 2020; 18:1. [PMID: 31931808 PMCID: PMC6958750 DOI: 10.1186/s12947-020-0185-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite significant improvements in cardiopulmonary resuscitation, sudden cardiac arrest is one of the leading causes of mortality in the United States. Ultrasound is a widely available tool that can be used to evaluate the presence of cardiac wall motion during cardiac arrest. Several clinical studies have evaluated the use of ultrasound to visualize cardiac motion as a predictor of mortality in cardiac arrest patients. However, there are limited data summarizing the prognostic value of point of care ultrasound evaluation during resuscitation. We performed a systematic literature review of the existing evidence examining the clinical utility of point-of-care ultrasound evaluation of cardiac wall motion as a predictor of cardiac resuscitation outcomes. METHODS/RESULTS We performed a systematic PubMed search of clinical studies up to July 23, 2019 evaluating point-of-care sonographic cardiac motion as a predictor of mortality following cardiac resuscitation. We included studies written in English that reviewed short-term outcomes and included adult populations. Fifteen clinical studies met inclusion criteria for assessing cardiac wall motion with point-of-care ultrasound and outcomes following cardiac resuscitation. Fourteen of the fifteen studies showed a statistically significant correlation between the presence of cardiac motion on ultrasound and short-term survival. This was most evident in patients with ventricular fibrillation or ventricular tachycardia as a presenting rhythm. Absence of cardiac motion non-survival. The data were pooled and the overall pooled odds ratio for return of spontaneous circulation in the presence of cardiac motion during CPR was 12.4 +/1 2.7 (p < 0.001). CONCLUSION Evaluation of cardiac motion on transthoracic echocardiogram is a valuable tool in the prediction of short-term cardiac resuscitation outcomes. Given the safety and availability of ultrasound in the emergency department, it is reasonable to apply point-of-care ultrasound to cardiopulmonary resuscitation as long as its use does not interrupt resuscitation.
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Affiliation(s)
- Ilan Kedan
- Smidt Heart Institute, Cedars-Sinai Medical Center, 8501 Wilshire Blvd. Suite 200, Beverly Hills, Los Angeles, CA, 90211, USA.
| | - William Ciozda
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joseph A Palatinus
- Smidt Heart Institute, Cedars-Sinai Medical Center, 8501 Wilshire Blvd. Suite 200, Beverly Hills, Los Angeles, CA, 90211, USA
| | - Helen N Palatinus
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Asher Kimchi
- Smidt Heart Institute, Cedars-Sinai Medical Center, 8501 Wilshire Blvd. Suite 200, Beverly Hills, Los Angeles, CA, 90211, USA
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Elfwén L, Hildebrand K, Schierbeck S, Sundqvist M, Ringh M, Claesson A, Olsson J, Nordberg P. Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients. Resuscitation 2019; 142:16-22. [DOI: 10.1016/j.resuscitation.2019.06.282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
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Abstract
Cardiac arrest remains a significant cause of death and disability throughout the world. However, as our understanding of cardiac arrest and resuscitation physiology has developed, new technologies are fundamentally altering our potential to improve survival and neurologic sequela. Some advances are relatively simple, requiring only alterations in current basic life support measures or integration with pre-hospital organization, whereas others, such as extra-corporeal membrane oxygenation, require significant time and resource investments. When combined with consistent rescuer and patient-physiologic monitoring, these innovations allow an unprecedented capacity to personalize cardiac arrest resuscitation to patient-specific pathophysiology. However, as more extensive options are established, it can be difficult for providers to incorporate novel resuscitation techniques into a cardiac arrest protocol which can fit a wide variety of cases with varying complexity. This article will explore recent advances in our understanding of cardiac arrest physiology and resuscitation sciences, with particular focus on the metabolic phase after significant ischemia has been induced. To this end, we establish a practical consideration for providers seeking to integrate novel advances in cardiac arrest resuscitation into daily practice.
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Affiliation(s)
- Cyrus E Kuschner
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA
| | - Lance B Becker
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA
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Merlin MA, Joseph J, Hohbein J, Ariyaprakai N, Tanis J, Tagore A. Out-of-Hospital Transesophageal Echocardiogram for Cardiac Arrest Resuscitation: The Initial Case. PREHOSP EMERG CARE 2019; 24:90-93. [DOI: 10.1080/10903127.2019.1604926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vaishnav M, Sedgwick J. Point-of-care echocardiography - A road to future or a step backwards. Australas J Ultrasound Med 2019; 22:26-31. [PMID: 34760533 DOI: 10.1002/ajum.12128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Echocardiography (Echo) has a myriad of clinical applications. Traditionally, it was performed and interpreted by cardiologist but the scope of its applications has lead physicians of other specialities to learn this useful skill. One of the newer and expanding scope of echocardiography is point-of-care (POC) echocardiography. In this review article, we aim to discuss the clinical applications of POC echo, common protocols and its limitations. Despite its widespread use, there is paucity of data describing its clinical efficacy and there is lack of guidelines regarding credentialing and quality control of POC echo.
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Affiliation(s)
- Manan Vaishnav
- The Prince Charles Hospital Brisbane Queensland Australia.,The Gold Coast University Hospital Southport Queensland Australia
| | - John Sedgwick
- The Prince Charles Hospital Brisbane Queensland Australia.,The University of Queensland St Lucia Queensland Australia
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