References

Aichinger G, Zechner PM, Prause G Cardiac movement identified on prehospital echocardiography predicts outcome in cardiac arrest patients. Prehosp Emerg Care. 2012; 16:(2)251-255

Blaivas M, Fox JC Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram. Acad Emerg Med. 2001; 8:(6)616-21

Blyth L, Atkinson P, Gadd K, Lang E Bedside focused echocardiography as predictor of survival in cardiac arrest patients a systematic review. Acad Emerg Med. 2012; 19:1119-26

Breitkreutz R Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010; 81:(11)1527-1533

Thorax. 2003; 58:470-484

Brun PM, Bessereau J, Chenaitia H, Pradel AL, Deniel C Stay and play EFAST or scoop and run EFAST? That is the question!. Am J Emerg Med. 2014; 32:(2)166-70

Busch M Portable ultrasound in prehospital emergencies: a feasibility study. Acta Anaesthesiologica Scandinavica. 2006; 50:(6)754-748

Callaway CW, Soar J, Aibiki M, Bottiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O'Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J Part 4: Advanced life support. 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015; 132:(16)

Chardoli M, Heidari F, Rabiee H, Sharif-Alhoseini M, Shokoohi H, Rahimi-Movaghar V Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest. Chin J Traumatol. 2012; 15:284-287

Chatterjee S, Chakraborty A, Weinberg I Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage. 2014; A meta-analysis. JAMA:(23)2414-2421

Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD European Resuscitation Council Guidelines for resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010; 81:(10)1305-1352

Ferrada P, Wolfe W, Anand R, Whelan J, Vanguri P, Malhotra A, Goldberg S, Duane T, Aboutanos M Use of limited transthoracic echocardiography in patients with traumatic cardiac arrest decreases the rate of nontherapeutic thoracotomy and hospital costs. J Ultrasound Med. 2014; 33:(10)1829-1832

Fevang E, Lockey D, Thompson J The top five research priorities in physician-provided prehospital critical care: a consensus report from a European research collaboration. Scand J Trauma Resusc Emerg Med. 2011; 19

Hernandez C, Shuler K, Hannah H, Sonyika C, Likourezos A, Marshall J C.A.U.S.E: Cardiac arrest ultra sound exam: a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation. 2008; 76:(2)

Knowles P Thoracic echocardiography during cardiac arrest due to massive pulmonary embolism. EMJ. 2003;

Kronick SL, Kurz MC, Edelson DP, Berg RA, Billi JE, Cabanas JG, Cone DC, Diercks DB, Foster J, Meeks RA, Travers AH, Welsford M Part 4: systems of care and continuous quality improvement. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132:(18)

Lilly LS Pathophysiology of heart disease: a collaborative project of medical students and faculty, Edition 6. China: Wolters Kluwer; 2016

Lopez-Candales A, Edelman K, Candales MD Right ventricular apical contractility in acute pulmonary embolism: the McConnell Sign revisited. Echocardiography. 2010; 27:(6)614-620

Mai TV, Ahn DT, Phillips CT, Agan DL, Kimura BJ Feasibility of remote real-time guidance of a cardiac examination performed by novices using a pocket-sized ultrasound device. Emerg Med Int. 2013; 1-5

Mazur SM, Pearce A, Sam A, Goudie A, Sharley P The F.A.S.T.E.R. trial: focused assessment by sonography in trauma during emergency retrieval: a feasibility study. Injury. 2008; 39:(5)512-518

McConnell MV, Soloman SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol. 1996; 78:(4)469-473

Nicol G, Rumsfeld J, Eigel B, Abella BS, Labarthe D, Hong Y, O'Connor RE, Mosesso VN, Berg RA, Leeper B, Weisfeldt ML Essential features of designating out-of-hospital cardiac arrest as a reportable event: American Heart Association Scientific Statement. Circulation. 2008; 117:(17)

Niendorff D, Rassias AJ, Palac R, Beach ML, Costa S, Greenberg M Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers. Resuscitation. 2005; 67:(1)81-87

Rabiei H, Rahimi-Movaghar V Application of ultrasound in pulseless electrical activity (PEA) cardiac arrest. Med J Islam Repub Iran. 2016; 30

Reed MJ, Gibson L, Dewar A, Short S, Black P, Clegg GR Introduction of paramedic led Echo in Life Support into the prehospital environment: The PUCA study. Resuscitation. 2016; 112:65-69

Robson R Echocardiography during CPR: more studies needed. Resuscitation. 2010; 81:(11)1453-1454

Salen P, Melniker L, Chooljian C, Rose JS, Alteveer J Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients. Am J Emerg Med. 2005; 23:(4)459-62

Sanders AB, Kern KB, Berg RA Searching for a predictive rule for terminating cardiopulmonary resuscitation. Acad Emerg Med. 2001; 8:(6)654-7

Snaith B, Hardy M, Walker A Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes. EMJ. 2011; 28:(12)

Su MJ, Ma HM, Ko CI Application of tele-ultrasound in emergency medical services Telemed. J E Health. 2008; 14:816-824

Tayal VS, Kline JA Emergency echocardiograohy to detect pericardial effusion in patients in PEA and near-PEA states. Resuscitation. 2003; 59:(3)315-318

Torbicki A, Tramarin R, Morpurgo M Role of echo/Doppler in the diagnosis of pulmonary embolism. Clin Cardiol. 1992; 15:805-810

Vaswani A, Khaw HJ, Dougherty S, Zamvar V, Lang CC Cardiology in a heartbeat.Banbury: Scion Publishing Limited; 2016

Viera AJ, Bangdiwala SI Eliminating bias in radomized controlled trials: importance of allocation concealment and masking. Fam Med. 2007; 39:(2)132-7

Walker E Ultrasound: a potential new approach for cardiac arrest management. J Paramedic Practice. 2017; 9:(3)103-107

Zhang Z Echocardiography for patients undergoing extracorporeal cardiopulmonary resuscitation: a primer for intensive care physicians. J Intensive Care. 2017; 5:(15)

Cardiac arrest and the role of transthoracic echocardiography

02 October 2017
Volume 9 · Issue 10

Abstract

The role of transthoracic echocardiography (TTE) is one of the top five research priorities in prehospital critical care (Fevang et al, 2011). TTE is a non-invasive diagnostic tool in cardiac arrest, using ultrasound images to visualise the real-time activity of the heart (Hernandez et al, 2008). TTE has the potential to reduce the time between the onset of cardiac arrest and appropriate therapy. There are several reversible causes of cardiac arrest that can be identified by TTE in the pre-hospital environment. The method and value of identifying pulmonary emboli (PE), cardiac tamponade and hypovolaemia will be discussed. Equally, TTE can exclude certain reversible causes, indicating that the cardiac arrest is of an irreversible nature and the resuscitation attempt is futile. The application of TTE in this context will be reviewed in depth, from the current literature to the physical practicalities. As such, the aim of the present study is to clarify the role of TTE in patients suffering out-of-hospital cardiac arrest.

The American Heart Association (AHA) 2020 Impact Goals aim to increase out-of-hospital cardiac arrest (OHCA) survival from 7.9% to 15% between 2010 and 2020 (Kronick et al, 2015). Both in-hospital and prehospital systems have the potential to substantially improve cardiac arrest care. The European Resuscitation Council (ERC) Guidelines 2010 state that ultrasound might be of diagnostic assistance and guide subsequent treatment of reversible causes (Deakin et al, 2010). The AHA also supports the use of transthoracic echocardiography (TTE) with the condition that it must not interfere with advanced life support (ALS) protocol—particularly chest compressions (Kronick et al, 2015). This can be achieved by performing TTE in the 10-second pulse check window as studies have successfully demonstrated without significant difficulty (Callaway et al, 2015).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed