‘POCUS in Cardiac Arrest’
As many as 75% of patients in PEA cardiac arrest (medical) are demonstrated to have cardiac activity with ultrasound (pseudo-PEA). Pseudo-PEA has a high correlation with survival compared to true PEA if identified early and treated appropriately.
POCUS may have a role in cardiac arrest and aims to answer questions which may guide resuscitation decisions specifically with respect to the following:
- Is there a pericardial effusion?
- Is there a massive haemoperitoneum?
- Is there cardiac standstill?
- Is the heart empty or full? (Hypovolaemia)
- Is the heart beating well or poorly? (Cardiogenic shock)
Obtaining the View
- The principles of obtaining the views are similar to those described in ‘Pump’. The key difference during cardiac arrest is in circumstances where chest compressions are indicated that compressions are not withheld for lengthy periods of time while POCUS is being performed.
- During Traumatic Cardiac Arrest routine protocol is to ensure optimal ventilation and the conduct of bilateral open thoracostomies. Therefore, lung ultrasound is omitted.
- The ultrasound is prepared in anticipation of a pulse/ rhythm check and just prior to cessation of compressions the probe is placed on the chest and the video clip is started allowing a 10 second window (RUQ/ heart) to be obtained during the pulse/ rhythm check. This is then reviewed after compressions have resumed.
- Select the abdominal OR cardiac probe and optimise settings. Set a depth of 16cm.
- Place gel and position the probe for a SXV shortly before the pulse check and start recording.
- At pulse check obtain SXV.
- During following compressions, review the stored clip.
- Repeat for RUQ view.