CHEST Guidelines-Ultrasound-Diagnosis-of-Cardiac-Arrest-in-a P

Ultrasound-Diagnosis-of-Cardiac-Arrest-in-a P

Pdf Summary

The case study discusses a 52-year-old woman who experienced cardiac arrest (CA) in a hematologic ward. She had a history of breast cancer and acquired von Willebrand disease. The initial CA was marked by pulseless electrical activity (PEA), and return to spontaneous circulation (ROSC) was achieved after 25 minutes of advanced cardiac life support (ACLS). Despite stabilization and transfer to the ICU, she suffered a second CA. Ultrasound performed during the pulse check revealed pseudo-PEA with dilated right ventricle (RV), interventricular septum (IVS) flattening, and clots in the right heart, leading to a diagnosis of acute cor pulmonale caused by massive pulmonary embolism (PE).<br /><br />The case emphasizes the importance of point-of-care ultrasound in detecting treatable causes of CA, distinguishing between true and pseudo-PEA, and identifying conditions such as acute cor pulmonale. Ultrasound findings, including a dilated RV and visible thrombi, can guide therapeutic decisions like administering thrombolytics or performing thrombectomy. The discussion also notes chronic conditions that might mimic these ultrasound findings, such as chronic RV dilation due to pulmonary hypertension.<br /><br />Point-of-care ultrasound, if performed systematically and promptly, can assist in diagnosing and addressing potentially reversible causes of CA, although it must not hinder effective CPR efforts. The study underscores that while the direct impact of ultrasound on outcomes isn't proven, it aids in diagnosing life-threatening conditions like massive PE, which, if treated promptly, might be life-saving. However, in this case, despite interventions, the patient did not achieve ROSC following the second CA. The document highlights the importance of incorporating ultrasound into resuscitative efforts for diagnosing underlying causes of nonshockable CA rhythms.

Keywords

cardiac arrest

pulseless electrical activity

point-of-care ultrasound

acute cor pulmonale

pulmonary embolism

advanced cardiac life support

right ventricle dilation

thrombolytics

pseudo-PEA

resuscitative efforts