Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest

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• 作者：Romolo Gaspari^a ; ^{Romolo.Gaspari@umassmemorial.org} ; Anthony Weekes^b ; Srikar Adhikari^c ; Vicki E. Noble^d ; Jason T. Nomura^e ; Daniel Theodoro^f ; Michael Woo^g ; Paul Atkinson^h ; David Blehar^a ; Samuel M. Brownⁱ ; Terrell Caffery^j ; Emily Douglass^d ; Jacqueline Fraser^h ; Christine Haines^k ; Samuel Lam^l ; Michael Lanspaⁱ ; Margaret Lewis^b ; Otto Liebmann^m ; Alexander Limkakengⁿ ; Fernando Lopezⁿ ; Elke Platz^o ; Michelle Mendoza^a ; Hal Minnigan^p ; Christopher Moore^q ; Joseph Novik^r ; Louise Rang^s ; Will Scruggs^t ; Christopher Raio^k
• 关键词：Cardiac arrest ; Ultrasound ; Resuscitation
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：109
• 期：Complete
• 页码：33-39
• 全文大小：641 K
• 卷排序：109

文摘

Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival.MethodsWe conducted a non-randomized, prospective, protocol-driven observational study at 20 hospitals across United States and Canada. Patients presenting with out-of-hospital arrest or in-ED arrest with pulseless electrical activity or asystole were included. An ultrasound was performed at the beginning and end of ACLS. The primary outcome was survival to hospital admission. Secondary outcomes included survival to hospital discharge and return of spontaneous circulation.Findings793 patients were enrolled, 208 (26.2%) survived the initial resuscitation, 114 (14.4%) survived to hospital admission, and 13 (1.6%) survived to hospital discharge. Cardiac activity on US was the variable most associated with survival at all time points. On multivariate regression modeling, cardiac activity was associated with increased survival to hospital admission (OR 3.6, 2.2–5.9) and hospital discharge (OR 5.7, 1.5–21.9). No cardiac activity on US was associated with non-survival, but 0.6% (95% CI 0.3–2.3) survived to discharge. Ultrasound identified findings that responded to non-ACLS interventions. Patients with pericardial effusion and pericardiocentesis demonstrated higher survival rates (15.4%) compared to all others (1.3%).ConclusionCardiac activity on ultrasound was the variable most associated with survival following cardiac arrest. Ultrasound during cardiac arrest identifies interventions outside of the standard ACLS algorithm.