Bedside ultrasound in cardiac standstill: a clinical review

Abstract

Patients with cardiac arrest present as a relatively frequent occurrence in the Emergency Department. Despite the advances in our understanding of the pathophysiology of cardiac arrest, managing the condition remains a stressful endeavor and currently implemented interventions, while beneficial, are still associated with a disappointingly low survivability. The majority of modern Advanced Life Support algorithms employ a standardized approach to best resuscitate the 'crashed' patient. However, management during resuscitation often encourages a 'one-size-fitsall' policy for most patients, with lesser attention drawn towards causality of the disease and factors that could alter resuscitative care. Life support providers are also often challenged by the limited bedside predictors of survival to guide the course and duration of resuscitation. Over the recent decades, point-of-care ultrasonography (PoCUS) has been gradually proving itself as a useful adjunct that could potentially bridge the gap in the recognition and evaluation of precipitants and end-points in resuscitation, thereby facilitating an improved approach to resuscitation of the arrested patient. Point-of-care ultrasound applications in the critical care field have tremendously evolved over the past four decades. Today, bedside ultrasound is a fundamental tool that is quick, safe, inexpensive and reproducible. Not only can it provide the physician with critical information on reversible causes of arrest, but it can also be used to predict survival. Of note is its utility in predicting worse survival outcomes in patients with cardiac standstill, i.e., no cardiac activity witnessed with ultrasound. Unfortunately, despite the increasing evidence surrounding ultrasound use in arrest, bedside ultrasound is still largely underutilized during the resuscitation process. This article reviews the current literature on cardiac standstill and the application of bedside ultrasound in cardiac arrests.

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

“…Other authors ( 5 , 6 ) have proposed algorithms incorporating POCUS during cardiac arrest resuscitation. While we recognise that there may be differences between each institution’s protocol for cardiac arrest resuscitation, the key principle is to ensure that cardiac compressions are not delayed due to POCUS ( 7 ) .…”

“…Other authors (5,6) have proposed algorithms incorporating POCUS during cardiac arrest resuscitation. While we recognise that there may be differences between each institution's protocol for cardiac arrest resuscitation, the key principle is to ensure that cardiac compressions are not delayed due to POCUS (7) . This recommendation is made considering the foremost need to ensure adequate cardiac output through cardiac compressions during cardiac arrest for the patient, which would override the importance of obtaining the diagnosis.…”

Uso do ultrassom point-of-care (POCUS) na parada cardiorrespiratória (PCR)

“…A parada cardíaca é um dos principais desencadeadores de mortalidade e invalidez em todo o mundo (HUSSEIN L, et al, 2019). Ela se configura como uma das mais importantes causas de morte e morbidade, no Brasil e no mundo.…”

“…Já na última década, a Sociedade Americana de Ecocardiografia e o Colégio Americano de Médicos de Emergência constituíram um consenso a respeito das atribuições do ultrassom nas emergências cardiovasculares (HUSSEIN L, et al, 2019).…”

Ecocardiografía en reanimación cardiopulmonar

“…l paro cardiorrespiratorio (PCR) es una entidad clínica que se encuentra con frecuencia en las Unidades de Emergencia de Adultos y las técnicas de reanimación cardiopulmonar (RCP) constituyen una parte integral de la capacitación central de cada proveedor de atención médica de emergencia. La RCP en el servicio de urgencias es un evento importante que moviliza la sala de reanimación y requiere una rápida toma de decisiones y una intervención sistemática [1]. Según las estadísticas de la American Heart Association de 2013, la tasa de sobrevida global al alta hospitalaria fue de 9,5% y de 23,9% para el PCR extrahospitalario e intrahospitalario, respectivamente [1].…”