CHEST Guidelines-Ultrasound-Diagnosis-of-Cardiac-Arrest-in-a P (1)

Ultrasound-Diagnosis-of-Cardiac-Arrest-in-a P (1)

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The article discusses the case of a 52-year-old woman who experienced cardiac arrest (CA) while hospitalized in a hematologic ward. Her medical history included breast cancer, treatment for acquired von Willebrand disease, and severe thrombocytosis. Initial resuscitation efforts showed she had a nonshockable pulseless electrical activity (PEA) rhythm. Despite the absence of ultrasound during initial resuscitation efforts, return of spontaneous circulation (ROSC) was achieved after 25 minutes.<br /><br />Upon arrival in the ICU, an ultrasound conducted following a subsequent CA revealed a dilated right ventricle (RV) with motion of the interventricular septum (IVS) suggesting pressure overload, indicative of acute cor pulmonale. Additionally, clots were observed moving in the heart's right cavities and the inferior vena cava (IVC) was filled with thrombi, indicating a massive pulmonary embolism (PE) as the cause of CA. <br /><br />The importance of point-of-care ultrasound in detecting treatable causes of CA, specifically in cases with nonshockable rhythms, is emphasized. Ultrasound helps to ascertain pseudo-PEA by identifying residual wall motion, which may indicate a better prognosis and guide further treatment. It can reveal various cardiac issues like acute RV dilation, impaired left ventricle (LV) functions, and signs of pulmonary embolism that require urgent intervention including thrombolysis or thrombectomy.<br /><br />The discussion reflects on the need for early diagnosis of PE to improve patient outcomes especially in those with hemodynamic instability. While ultrasound increases diagnosis accuracy, its effectiveness must be carefully balanced to not interrupt cardiopulmonary resuscitation (CPR), ensuring critical life-support interventions continue effectively. Even with advanced life support measures, the patient unfortunately did not survive. <br /><br />The article provides insight into the use of ultrasound for diagnosing causes of CA in a hematologic context, highlighting its potential to guide therapeutic decision-making in emergencies.

Keywords

cardiac arrest

pulseless electrical activity

point-of-care ultrasound

pulmonary embolism

acute cor pulmonale

thrombocytosis

thrombolysis

interventricular septum

resuscitation

hemodynamic instability