Ultrasound in Cardiopulmonary Arrest: State of Art Ultrasound in Cardiac Arrest
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Abstract
Sudden cardiac or cardiorespiratory (CPA) arrest accounts for about half of all deaths from cardiovascular causes and is one of the leading causes of death in adults in developed and developing countries. Effective treatment of CPA consists of prompt care with high-quality cardiopulmonary resuscitation (CPR), early defibrillation at shocking rhythms, identification of the cause of CPA, and post-arrest care. Despite constantly updated and widely disseminated CPR guidelines, mortality from CRA is still very high, and there is significant heterogeneity of CRP causes and the inherent prognosis of each cause. In general, patients in CPA whose initial rhythm is non-shockable present a more significant challenge in identifying the cause of CPA. In this context, the ultrasound handled by the rescuer and used as an extension of the physical examination during CPR is associated with faster and more specific diagnoses and, consequently, a more significant number of specific treatments and a potentially better prognosis. Ultrasound can also be used to diagnose CRP and monitor the quality of CPR, guide procedures, and infer prognosis. In the last decade, many scientific publications have supported the use of ultrasound in CPR maneuvers, with a demonstration of a better prognosis in some subgroups. Currently, ultrasound is incorporated in emergency units of excellence as a fundamental resource for various situations. The purpose of this review is to provide information on the state-of-the-art use of ultrasound in CPA.
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References
- Lentz B, Fong T, Rhyne R, Risko N. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. Ultrasound J. 2021 Mar 9;13(1):16. https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-021-00216-8
- Nelson BP, Melnick ER, Li J. Portable ultrasound for remote environments, part I: Feasibility of field deployment. J Emerg Med. 2011;40(2):190–197. https://www.jem-journal.com/article/S0736-4679(09)00784-7/fulltext
- Moore C, Molina A, Lin H. Ultrasonography in community emergency departments in the United States: access to ultrasonography performed by consultants and status of emergency physician performed ultrasonography. Ann Emerg Med 2006;47:147–53.https://www.annemergmed.com/article/S0196-0644(05)01586-6/fulltext
- Prager R, Pratte M, Guy A, Bala S, Bachar R, Kim DJ, et al., Completeness of reporting for systematic reviews of point-of-care ultrasound: a meta-research study. BMJ Evid Based Med. 2021 Mar 30:bmjebm-2020-111652.https://ebm.bmj.com/content/early/2021/03/30/bmjebm-2020-111652
- Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015 Jun;147(6):1659-1670.https://journal.chestnet.org/article/S0012-3692(15)37223-8/fulltext
- Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am. 2010 Feb;28(1):29-56, vii. https://www.sciencedirect.com/science/article/abs/pii/S0733862709001175?via%3Dihub
- Desai N, Garry D. Assessing dynamic fluid-responsiveness using transthoracic echocardiography in intensive care. BJA Educ. 2018 Jul;18(7):218-226.
https://bjaed.org/article/S2058-5349(18)30039-8/fulltext
- Feller-Kopman D. Ultrasound-guided thoracentesis. Chest. 2006 Jun;129(6):1709-14.https://journal.chestnet.org/article/S0012-3692(15)50777-0/fulltext
- Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017 Aug 28;21(1):225.https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1814-y
- Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, et al., European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021 Apr;47(4):369-421.https://portal.research.lu.se/portal/en/publications/european-resuscitation-council-and-european-society-of-intensive-care-medicine-guidelines-2021(c32ac8da-51ed-45f7-93b5-92ee77c48c7e)/export.html
- Azeli Y, Barbería E, Jiménez-Herrera M, Bonet G, Valero-Mora E, Lopez-Gomariz A, et al. The ReCaPTa study - a prospective out of hospital cardiac arrest registry including multiple sources of surveillance for the study of sudden cardiac death in the Mediterranean area. Scand J Trauma Resusc Emerg Med. 2016;24:127.https://link.springer.com/article/10.1186/s13049-016-0309-1
- Gräsner JT, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, et al. and EuReCa ONEC. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of- hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016;105:188-95.https://www.resuscitationjournal.com/article/S0300-9572(16)30099-5/fulltext
- Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S444-64. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000261
- Olasveengen TM, de Caen AR, Mancini ME, Maconochie IK, Aickin R, Atkins DL, et al.; ILCOR Collaborators. 2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary. Circulation. 2017 Dec 5;136(23):e424-e440.https://www.ahajournals.org/doi/10.1161/cir.0000000000000541
- 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 Dec 4;13(1):62.https://intjem.biomedcentral.com/articles/10.1186/s12245-020-00319-4
- Gaspari R, Weekes A, Adhikari S, Noble V, Nomura JT, Theodoro D, et al. A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study. Resuscitation. 2017 Nov;120:103-107.https://www.resuscitationjournal.com/article/S0300-9572(17)30607-X/fulltext
- Lam V, Hsu CH. Updates in Cardiac Arrest Resuscitation. Emerg Med Clin North Am. 2020 Nov;38(4):755-769.https://www.sciencedirect.com/science/article/abs/pii/S0733862720300596?via%3Dihub
- Martinez JP. Prognosis in cardiac arrest. Emerg Med Clin North Am. 2012 Feb;30(1):91-103. https://pubmed.ncbi.nlm.nih.gov/22107977/
- Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European resuscitation council guidelines for resuscitation 2015: section 3. Adult Advanced life support. Resuscitation. 2015;95:100–147.https://www.resuscitationjournal.com/article/S0300-9572(15)00328-7/fulltext
- Miesemer B. Using Ultrasound for Cardiac Arrest POCUS can improve detection and treatment of underlying pathologies. EMS World. 2017 Feb;46(2):40-42. https://pubmed.ncbi.nlm.nih.gov/29847057/
- Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, et al. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S465-82.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000262
- Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018 Oct 2;72(14):e91-e220.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
- Rabjohns J, Quan T, Boniface K, Pourmand A. Pseudo-pulseless electrical activity in the emergency department, an evidence-based approach. Am J Emerg Med. 2020 Feb;38(2):371-375. https://www.sciencedirect.com/science/article/abs/pii/S0735675719306527?via%3Dihub
- Salen P, Melniker L, Chooljian C, Rose JS, Alteveer J, Reed J, Heller M. Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients? Am J Emerg Med. 2005 Jul;23(4):459-62. https://www.sciencedirect.com/science/article/abs/pii/S0735675705001269?via%3Dihub
- Teran F, Dean AJ, Centeno C, Panebianco NL, Zeidan AJ, Chan W, Abella BS. Evaluation of out-of-hospital cardiac arrest using transesophageal echocardiography in the emergency department. Resuscitation. 2019 Apr;137:140-147. https://www.resuscitationjournal.com/article/S0300-9572(18)30976-6/fulltext
- Zengin S, Gümüşboğa H, Sabak M, Eren ŞH, Altunbas G, Al B. Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients. Resuscitation. 2018 Dec;133:59-64. https://www.resuscitationjournal.com/article/S0300-9572(18)30903-1/fulltext
- Breitkreutz R, Price S, Steiger HV, Seeger FH, Ilper H, Ackermann H, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010;81(11):1527–1533.https://www.resuscitationjournal.com/article/S0300-9572(10)00416-8/fulltext
- Keikha M, Salehi-Marzijarani M, Soldoozi Nejat R, Sheikh Motahar Vahedi H, Mirrezaie SM. Diagnostic Accuracy of Rapid Ultrasound in Shock (RUSH) Exam; A Systematic Review and Meta-analysis. Bull Emerg Trauma. 2018 Oct;6(4):271-278.https://pubmed.ncbi.nlm.nih.gov/30402514/
- Marbach JA, Almufleh A, Di Santo P, Simard T, Jung R, Diemer G, et al. A Shifting Paradigm: The Role of Focused Cardiac Ultrasound in Bedside Patient Assessment. Chest. 2020 Nov;158(5):2107-2118. https://journal.chestnet.org/article/S0012-3692(20)31950-4/fulltext
- Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, Marshall J. C.A.U.S.E.: cardiac arrest ultra-sound exam—a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation. 2008;76(2):198–206.https://www.resuscitationjournal.com/article/S0300-9572(07)00420-0/fulltext
- Breitkreutz R, Walcher F, Seeger FH. Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm. Crit Care Med. 2007;35(5 Suppl):S150–S161.https://pubmed.ncbi.nlm.nih.gov/17446774/
- Testa A, Cibinel GA, Portale G, Forte P, Giannuzzi R, Pignataro G, Silveri NG. The proposal of an integrated ultrasonographic approach into the ALS algorithm for cardiac arrest: the PEA protocol. Eur Rev Med Pharmacol Sci. 2010;14(2):77–88.https://europepmc.org/article/med/20329565
- Lichtenstein D, Malbrain ML. Critical care ultrasound in cardiac arrest. Technological requirements for performing the SESAME-protocol—a holistic approach. Anaesthesiol Intensive Ther. 2015;47(5):471–481.https://www.termedia.pl/Critical-care-ultrasound-in-cardiac-arrest-r-nTechnological-requirements-for-performing-r-nthe-SESAME-protocol-a-holistic-approach,118,38310,0,1.html
- Casella F, Schiavon R, Ceriani E, Cogliati C. I Will Be at Your (Bed)Side - The Role of Bedside Echocardiography for Non-Cardiologists. Ultraschall Med. 2020 Aug;41(4):362-386.https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-1198-4980
- Querellou E, Leyral J, Brun C, Lévy D, Bessereau J, Meyran D, Le Dreff P. In and out-of-hospital cardiac arrest and echography: a review. Ann Fr Anesth Reanim. 2009;28(9):769–778.https://www.sciencedirect.com/science/article/abs/pii/S075076580900327X?via%3Dihub
- Atkinson P, Bowra J, Milne J, Lewis D, Lambert M, Jarman B, et al. International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest. CJEM. 2017 Nov;19(6):459-470.https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/international-federation-for-emergency-medicine-consensus-statement-sonography-in-hypotension-and-cardiac-arrest-shoc-an-international-consensus-on-the-use-of-point-of-care-ultrasound-for-undifferentiated-hypotension-and-during-cardiac-arrest/1220D0A3B853EE22B6FB0294F1CD0D67
- Parker BK, Salerno A, Euerle BD. The Use of Transesophageal Echocardiography During Cardiac Arrest Resuscitation: A Literature Review. J Ultrasound Med. 2019 May;38(5):1141-1151. https://onlinelibrary.wiley.com/doi/abs/10.1002/jum.14794
- Blaivas M. Transesophageal echocardiography during cardiopulmonary arrest in the emergency department. Resuscitation. 2008;78(2):135–140.https://www.resuscitationjournal.com/article/S0300-9572(08)00128-7/fulltext
- Gaspari R, Weekes A, Adhikari S, Noble VE, Nomura JT, Theodoro D, et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation. 2016;109:33–39. https://www.resuscitationjournal.com/article/S0300-9572(16)30478-6/fulltext
- Weekes AJ, Thacker G, Troha D, Johnson AK, Chanler-Berat J, Norton HJ, Runyon M. Diagnostic Accuracy of Right Ventricular Dysfunction Markers in Normotensive Emergency Department Patients With Acute Pulmonary Embolism. Ann Emerg Med. 2016 Sep;68(3):277-91.https://www.annemergmed.com/article/S0196-0644(16)00037-8/fulltext
- Picano E, Scali MC, Ciampi Q, Lichtenstein D. Lung Ultrasound for the Cardiologist. JACC Cardiovasc Imaging. 2018 Nov;11(11):1692-1705.https://www.sciencedirect.com/science/article/pii/S1936878X18307605?via%3Dihub
- Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2012 Mar;141(3):703-708.https://journal.chestnet.org/article/S0012-3692(12)60160-3/fulltext
- Chardoli M, Heidari F, Rabiee H, Sharif-Alhoseini M, Shokoohi H, Rahimi-Movaghar V. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest. Chin J Traumatol. 2012;15(5):284–287. https://pubmed.ncbi.nlm.nih.gov/23069099/
- Amaya SC, Langsam A. Ultrasound detection of ventricular fibrillation disguised as asystole. Ann Emerg Med. 1999;33(3):344–346.https://www.annemergmed.com/article/S0196-0644(99)70372-0/fulltext
- Querellou E, Meyran D, Petitjean F, Le Dreff P, Maurin O. Ventricular fibrillation diagnosed with trans-thoracic echocardiography. Resuscitation. 2009;80(10):1211–1213.https://www.resuscitationjournal.com/article/S0300-9572(09)00329-3/fulltext
- Reynolds JC, Del Rios M. Point-of-care cardiac ultrasound during cardiac arrest: a reliable tool for termination of resuscitation? Curr Opin Crit Care. 2020 Dec;26(6):603-611.https://journals.lww.com/co-criticalcare/Abstract/2020/12000/Point_of_care_cardiac_ultrasound_during_cardiac.14.aspx
- Blyth L, Atkinson P, Gadd K, Lang E. Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Acad Emerg Med. 2012;19(10):1119–1126.https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712.2012.01456.x
- Flato UA, Paiva EF, Carballo MT, Buehler AM, Marco R, Timerman A. Echocardiography for prognostication during the resuscitation of intensive care unit patients with non-shockable rhythm cardiac arrest. Resuscitation. 2015;92:1–6. https://www.resuscitationjournal.com/article/S0300-9572(15)00149-5/fulltext
Tsou PY, Kurbedin J, Chen YS, Chou EH, Lee MG, Lee MC, Ma MH, Chen SC, Lee CC. Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis. Resuscitation. 2017 May;114:92-99.https://www.resuscitationjournal.com/article/S0300-9572(17)30083-7/fulltext
- Hwang SO, Zhao PG, Choi HJ, Park KH, Cha KC, Park SM, Kim SC, Kim H, Lee KH. Compression of the left ventricular outflow tract during cardiopulmonary resuscitation. Acad Emerg Med. 2009;16(10):928–933.https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712.2009.00497.x
- Kühn C, Juchems R, Frese W. Evidence for the ‘cardiac pump theory’ in cardiopulmonary resuscitation in man by transesophageal echocardiography. Resuscitation. 1991;22(3):275–282. https://www.resuscitationjournal.com/article/0300-9572(91)90035-W/pdf
- Liu P, Gao Y, Fu X, Lu J, Zhou Y, Wei X, et al. Pump models assessed by transesophageal echocardiography during cardiopulmonary resuscitation. Chin Med J (Engl) 2002;115(3):359–363.https://pubmed.ncbi.nlm.nih.gov/11940364/
- Lichtenstein D. How can the use of lung ultrasound in cardiac arrest make ultrasound a holistic discipline? The example of the SESAME-protocol. Med Ultrason. 2014;16(3):252–255. http://www.medultrason.ro/how-can-the-use-of-lung-ultrasound-in-cardiac-arrest-make-ultrasound-a-holistic-discipline-the-example-of-the-sesame-protocol/
- Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010;23(12):1225–1230.https://www.onlinejase.com/article/S0894-7317(10)00871-0/fulltext
- Blanco P, Martínez Buendía C. Point-of-care ultrasound in cardiopulmonary resuscitation: a concise review. J Ultrasound. 2017 Jul 31;20(3):193-198.https://link.springer.com/article/10.1007%2Fs40477-017-0256-3
- Long B, Alerhand S, Maliel K, Koyfman A. Echocardiography in cardiac arrest: An emergency medicine review. Am J Emerg Med. 2018 Mar;36(3):488-493. https://www.sciencedirect.com/science/article/abs/pii/S0735675717310331?via%3Dihub