Ultrasound: A potential new approach for cardiac arrest management

Ultrasound (US) is the use of high-frequency sound waves that create echoes when interfacing with underlying organs and tissue structures (UKAS 2008). The echoes are received and displayed as a visual image to the operator. US has been researched and implemented within pre-hospital care from the early 1990s within aeromedical transfers, and has been established as a point-of-care diagnostic tool over the past five years in doctor-led systems (Brun et al, 2013). The development of portable technology has enabled US scanning to become part of initial patient consultations. This review seeks to research its value and potential for early management and prediction for survival in out-of-hospital cardiac arrest (OHCA) in the medical patient compared with existing cardiac arrest markers.

OHCA management can be difficult; decision-making is often multi-factorial, and existing practices are unreliable and of varying sensitivity (Kern et al 2008). For example, it is well documented that an asystolic Electro-Cardiogram (ECG) may actually be Ventricular Fibrillation (VF) when seen with US (Kern et al 2008). End Tidal Carbon Dioxide (ETCO2) values do not give a reflection of long-term survival (Heradstveit et al, 2012; Touma and Davies, 2013). This prompted the question of how sensitive the current examination technique was and how it might change practice and decision-making within this cohort of patients.