Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

• Published in: Chinese journal of traumatology Vol. 15; no. 5; pp. 284 - 287
• Main Authors: Chardoli, Mojtaba, Heidari, Farhad, Shuang-ming, Song, Rabiee, Helaleh, Sharif-Alhoseini, Mahdi, Rahimi-Movaghar, Vafa, Shokoohi, Hamid
• Format: Journal Article
• Language: English
• Published: China Elsevier B.V 01.10.2012; Department of Emergency Medicine,Hazrate-Rasool Hospital,Tehran University of Medical Sciences,Tehran,Iran%Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences,Tehran 11365-3876,Iran%Department of Emergency Medicine,The George Washington University,Washington DC 20037,USA%Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences,Tehran 11365-3876,Iran Research Centre for Neural Repair,University of Tehran,Tehran,Iran
• Subjects: Cardiopulmonary Resuscitation; Echocardiography; Heart Arrest; Humans; Prospective Studies; Heart arrest; Cardiopulmonary resuscitation; Echocardiography
• ISSN: 1008-1275
• DOI: 10.3760/cma.j.issn.1008-1275.2012.05.005

To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes. In this prospective interventional study, patients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, peri-cardial effusion/tamponade and IVC size along with the advanced cardiac life support (ACLS) protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC) and death were evaluated in both groups. One hundred patients with the mean age of (58±6.1) years were enrolled in this study. Fifty patients(Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR). Among them, 7 patients (14%) had pericardial effusion, 11 (22%) had hypovolemia, and 39 (78%) were revealed the presence of MVA. In the pseudo PEA subgroup (presence of MVA), 43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA), there was no recorded ROSC (negative predictive value). Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed (P=0.52). Bedside echocardiography can identify some reversible causes of PEA. However, there are no significant changes in survival outcome between the echo group and those with traditional CPR.