Point-of-Care Ultrasound Use in Cardiac Arrest Patients.

Abstract

Over 350,000 patients experience out-of-hospital cardiac arrest annually in the United States. Patients presenting to the emergency department (ED) in cardiac arrest are critically ill and require emergent clinical decisions and treatment. Point-of-care ultrasound (POCUS) is useful as a rapid, bedside diagnostic imaging tool to help elucidate possible causes of cardiac arrest and guide management. Using a validated systematic approach such as the SHoC and CASA protocols, clinicians can safely perform POCUS with shortened pauses during pulse checks. POCUS is key in evaluating cardiac arrhythmias such as ventricular fibrillation (VF), which has higher survival rates with defibrillation, versus cardiac standstill, which has higher mortality per recent research studies. When performed by experienced users, POCUS also facilitates identification of reversible causes for improved cardiac arrest patient outcomes and can guide decisions in resuscitative efforts. In summary, this manuscript is a narrative review that illustrates identifiable POCUS findings and synthesizes them to guide potential emergent intervention in patients in cardiac arrest including: ventricular fibrillation, cardiac standstill, pericardial effusion, cardiac tamponade, right heart strain such as from acute pulmonary embolism, reduced cardiac function, wall motion abnormality, ruptured ventricular pseudoaneurysm, and aortic dissection.