Guiding Cardiopulmonary Resuscitation with Focused Echocardiography: A Report of Five Cases
Rachel Bo-Ming Liu , MD ORCID Icon, Sandy Bogucki , MD, PhD, Evie G. Marcolini, Connie Y. Yu, Charles R. Wira, Sharmin Kalam, show all
Received 01 Aug 2018, Accepted 30 May 2019, Accepted author version posted online: 31 May 2019
Download citation https://doi.org/10.1080/10903127.2019.1626955
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Abstract
Background: Focused transthoracic echocardiography has been used to determine etiologies of cardiac arrest and evaluate utility of continuing resuscitation after cardiac arrest. Few guidelines exist advising ultrasound timing within the advanced cardiac life support algorithm. Natural timing of echocardiography occurs during the pulse check, when views are unencumbered by stabilization equipment or vigorous movements. However, recent studies suggest that ultrasound performance during pulse checks prolongs the pause duration of cardiopulmonary resuscitation. Transesophageal echocardiography studies have demonstrated benefits in this regard, but there have been no transthoracic echocardiography studies assessing the physical performance of compressions during cardiopulmonary resuscitation.
Objective: To describe cases where echocardiography performed at the beginning of the cardiac arrest algorithm offers actionable information to cardiopulmonary resuscitation itself without delaying provision of compressions.
Conclusion: Providers using focused echocardiography to evaluate cardiac arrest patients should consider initiating scans at the start of compressions to identify the optimal location for compression delivery and to detect inadequate compressions. Subsequent visualization of full left ventricular compression may be seen after a location change, and combined with end tidal carbon dioxide values, gives indication for improved forward circulatory flow. Although it is not possible in all patients, doing so hastens provision of quality compressions that affect hemodynamic parameters without causing prolongations to the pulse check pause. Further research is needed to determine patient outcomes from both out-of-hospital and in-hospital cardiac arrest when cardiopulmonary resuscitation is visually guided by focused echocardiography.
Keywords: point-of-care ultrasound, echocardiography, cardiac arrest, cardiopulmonary resuscitation, emergency medicine
Rachel Bo-Ming Liu , MD ORCID Icon, Sandy Bogucki , MD, PhD, Evie G. Marcolini, Connie Y. Yu, Charles R. Wira, Sharmin Kalam, show all
Received 01 Aug 2018, Accepted 30 May 2019, Accepted author version posted online: 31 May 2019
Download citation https://doi.org/10.1080/10903127.2019.1626955
Select Language▼
Translator disclaimer
Accepted author version
Abstract
Background: Focused transthoracic echocardiography has been used to determine etiologies of cardiac arrest and evaluate utility of continuing resuscitation after cardiac arrest. Few guidelines exist advising ultrasound timing within the advanced cardiac life support algorithm. Natural timing of echocardiography occurs during the pulse check, when views are unencumbered by stabilization equipment or vigorous movements. However, recent studies suggest that ultrasound performance during pulse checks prolongs the pause duration of cardiopulmonary resuscitation. Transesophageal echocardiography studies have demonstrated benefits in this regard, but there have been no transthoracic echocardiography studies assessing the physical performance of compressions during cardiopulmonary resuscitation.
Objective: To describe cases where echocardiography performed at the beginning of the cardiac arrest algorithm offers actionable information to cardiopulmonary resuscitation itself without delaying provision of compressions.
Conclusion: Providers using focused echocardiography to evaluate cardiac arrest patients should consider initiating scans at the start of compressions to identify the optimal location for compression delivery and to detect inadequate compressions. Subsequent visualization of full left ventricular compression may be seen after a location change, and combined with end tidal carbon dioxide values, gives indication for improved forward circulatory flow. Although it is not possible in all patients, doing so hastens provision of quality compressions that affect hemodynamic parameters without causing prolongations to the pulse check pause. Further research is needed to determine patient outcomes from both out-of-hospital and in-hospital cardiac arrest when cardiopulmonary resuscitation is visually guided by focused echocardiography.
Keywords: point-of-care ultrasound, echocardiography, cardiac arrest, cardiopulmonary resuscitation, emergency medicine
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