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, 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.

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, 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.

Colapso de vena cava inferiorUna alternativa a la medición de presión venosa central como guía de reanimación hídrica en la sala de urgencias

Background In the current context of the SARS COVID-19 pandemic, where the main cause of death is respiratory failure, and since early recognition would allow timely measures to be implemented and probably improve outcomes, it is important to have tools that allow the emergency room to predict quickly and without the use of large resources which will need invasive mechanical ventilation. This study proposes using a new predictive index of noninvasive characteristics, based on the relationship between oxygenation and work of breathing measured by ultrasound-assessed diaphragmatic function, for the need for invasive mechanical ventilation in patients with SARS-COV2 infection who are admitted to the emergency department. Methods A prospective predictive cohort study was performed, collecting all patients admitted to the emergency room with respiratory failure (not severe or in imminent respiratory arrest) and a confirmed diagnosis of SARS-CoV-2 pneumonia. Diaphragmatic excursion measurements were taken within the first 24 h after admission to the department. The relationship between diaphragmatic excursion and SAFI was calculated, establishing the ultrasound diaphragmatic excursion So2/FiO2 index (U.D.E.S.I). The index’s performance was determined by analysis of sensitivity, specificity, and area under the curve (AUC). Results This pilot study analyzed the first 100 patients enrolled and found in-hospital mortality of 19%, all patients who died required mechanical ventilation, the right index showed a specificity of 82.4% with a sensitivity of 76.9%, likewise for the left index an overall specificity of 90.5% with a sensitivity of 65.3% was found. The ideal cut-off point for the right index is 1.485, and for the left index, the threshold point was 1.856. AUC of the right index is 0.798 (0.676–0.920) and of the left index 0.793 (0.674–0.911), when comparing them no significant differences were found between these values p = 0.871. Conclusion The relationship of So2/FiO2 and diaphragm excursion measured by both right and left ultrasound could predict the need for mechanical ventilation of the patient with COVID-19 pneumonia in the emergency room and could constitute a valuable tool since it uses noninvasive parameters and is easily applicable at the patient’s bedside. However, a more extensive study is needed to validate these preliminary results.