Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers

• Published in: Resuscitation Vol. 67; no. 1; pp. 81 - 87
• Main Authors: Niendorff, Daniel F., Rassias, Athos J., Palac, Robert, Beach, Michael L., Costa, Salvatore, Greenberg, Mark
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.10.2005; Elsevier
• Subjects: Adult; Advanced life support (ALS); Aged; Allied Health Personnel; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Cardiac arrest; Cardiac tamponade; Cardiac Tamponade - complications; Cardiac Tamponade - diagnostic imaging; Cardiopulmonary Resuscitation; Cardiopulmonary resuscitation (CPR); Clinical Competence; Critical Illness; Echocardiography, Doppler; Echocardiography, Transesophageal; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency Medical Services; Emergency Service, Hospital; Female; Heart Arrest - diagnostic imaging; Heart Arrest - etiology; Heart Arrest - mortality; Heart Arrest - therapy; Humans; Inpatients; Intensive care medicine; Life Support Systems; Male; Medical sciences; Middle Aged; Pulmonary embolism; Pulmonary Embolism - complications; Pulmonary Embolism - diagnostic imaging; Pulseless electrical activity (PEA); Quality of Health Care; Risk Assessment; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transthoracic echocardiography; United States; Ventricular Fibrillation - diagnostic imaging; Ventricular Fibrillation - etiology; Ventricular Fibrillation - mortality; Ventricular Fibrillation - therapy; Pulmonary embolism; Pulseless electrical activity (PEA); Advanced life support (ALS); Cardiac tamponade; Transthoracic echocardiography; Cardiac arrest; Cardiopulmonary resuscitation (CPR); Intensive cardiocirculatory care; Cardiocirculatory arrest; Intensive care; Echocardiography; Respiratory disease; Cardiovascular disease; Vascular disease; Heart disease; Pericardial disease; Ultrasound; Resuscitation
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2005.04.007

Cardiac arrest presenting as pulseless electrical activity (PEA) currently has a very low survival rate. Many of the conditions underlying PEA (cardiac tamponade, hypovolemia, and pulmonary embolus) are associated with specific cardiac ultrasound findings. The aim of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained nonexpert sonographers integrated into the ACLS response system at a major medical center. An emergency sonography system was created and deployed to each inpatient cardiac arrest occurring at Dartmouth Hitchcock Medical Center between November 1, 2003 and April 30, 2004. Thirteen internal medicine house officers received training to perform a limited subcostal cardiac ultrasound examination designed to diagnose cardiac tamponade, pulmonary embolus, severe hypovolemia, and lack of cardiac motion. Time from arrest alert to sonographic result, and correlation with over-reading by blinded echocardiography physicians were assessed. A complete emergency ultrasound examination was performed in five PEA arrests. The average time from arrest alert to interpretation was 7.75 min. (95% CI 2.8–18.3 min). Three of these examinations (60%, 95% CI 14.7–94.7%) were adequate for interpretation. Agreement between the nonexpert sonographer and echocardiography physician occurred in four of five (kappa = 0.706) cases. Rapid cardiac sonography can be successfully integrated in the ACLS response. Nonexpert sonographers may be able to provide useful interpretive information when sufficiently trained.