Ultrasound Diagnosis of Cardiac Arrest in a Patient With Hematologic Disease

Abstract

A 52-year-old woman suffered cardiac arrest (CA) while hospitalized in a hematologic ward. Her past medical history included breast cancer treated with radiotherapy and hormonal therapy, and acquired von Willebrand disease; she was undergoing testing for a newly detected severe thrombocytosis. Chest compressions were started immediately by nurses, followed by advanced cardiac life support (ACLS) started 4 min later, after the arrival of the intensivist. All rhythm checks showed nonshockable pulseless electrical activity (PEA) rhythm. Ultrasound was not available at that moment. Return to spontaneous circulation (ROSC) was obtained after 25 min; five doses of epinephrine were administered during resuscitation efforts. After ROSC, an ECG was negative for acute myocardial infarction and the patient was transferred to the ICU, intubated, and hemodynamically stable with no pharmacologic support. Once admitted to the ICU, while awaiting diagnostic in-depth analysis, she had a second CA; the cardiac monitor showed PEA. ACLS was immediately started and focused ultrasound was performed at the first pulse check pause.