Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest

被引：187

作者：

Gaspari, Romolo ^{[1
]}

Weekes, Anthony ^{[2
]}

Adhikari, Srikar ^{[3
]}

Noble, Vicki E. ^{[4
]}

Nomura, Jason T. ^{[5
]}

Theodoro, Daniel ^{[6
]}

Woo, Michael ^{[7
]}

Atkinson, Paul ^{[8
]}

Blehar, David ^{[1
]}

Brown, Samuel M. ^{[9
,10
]}

Caffery, Terrell ^{[11
]}

Douglass, Emily ^{[4
]}

Fraser, Jacqueline ^{[8
]}

Haines, Christine ^{[12
]}

Lam, Samuel ^{[13
]}

Lanspa, Michael ^{[9
,10
]}

Lewis, Margaret ^{[2
]}

Liebmann, Otto ^{[14
]}

Limkakeng, Alexander ^{[15
]}

Lopez, Fernando ^{[15
]}

Platz, Elke ^{[16
]}

Mendoza, Michelle ^{[1
]}

Minnigan, Hal ^{[17
]}

Moore, Christopher ^{[18
]}

Novik, Joseph ^{[19
]}

Rang, Louise ^{[20
]}

Scruggs, Will ^{[21
]}

Raio, Christopher ^{[12
]}

机构：

[1] Univ Massachusetts, Sch Med, Worcester, MA USA

[2] Carolinas Med Ctr, Charlotte, NC 28203 USA

[3] Univ Arizona, Tucson, AZ USA

[4] Massachusetts Gen Hosp, Boston, MA 02114 USA

[5] Christiana Care Hlth Syst, Newark, DE USA

[6] Washington Univ, Sch Med, St Louis, MO USA

[7] Univ Ottawa, Ottawa, ON, Canada

[8] Dalhousie Univ, St John, NB, Canada

[9] Intermt Med Ctr, Salt Lake City, UT USA

[10] Univ Utah, Salt Lake City, UT USA

[11] LSU Hlth Sci Ctr, Baton Rouge, LA USA

[12] North Shore Univ Hosp, Manhasset, NY USA

[13] Advocate Christ Med Ctr, Chicago, IL USA

[14] Brown Univ, Providence, RI 02912 USA

[15] Duke Univ, Sch Med, Durham, NC USA

[16] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[17] Indiana Univ, Indianapolis, IN 46204 USA

[18] Yale Univ, Sch Med, New Haven, CT USA

[19] NYU, Bellevue Hosp, New York, NY USA

[20] Kingston Gen Hosp, Kingston, ON, Canada

[21] Castle Hosp, Kailua, HI USA

来源：

RESUSCITATION | 2016年 / 109卷

关键词：

Cardiac arrest; Ultrasound; Resuscitation; PULSELESS ELECTRICAL-ACTIVITY; CARDIOPULMONARY-RESUSCITATION; LIFE-SUPPORT; SURVIVAL; ECHOCARDIOGRAPHY; SONOGRAPHY; PREDICTORS; DURATION; OUTCOMES; REGISTRY;

D O I：

10.1016/j.resuscitation.2016.09.018

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival. Methods: We conducted a non-randomized, prospective, protocol-driven observational study at 20 hospitals across United States and Canada. Patients presenting with out-of-hospital arrest or in-ED arrest with pulseless electrical activity or asystole were included. An ultrasound was performed at the beginning and end of ACLS. The primary outcome was survival to hospital admission. Secondary outcomes included survival to hospital discharge and return of spontaneous circulation. Findings: 793 patients were enrolled, 208 (26.2%) survived the initial resuscitation, 114 (14.4%) survived to hospital admission, and 13 (1.6%) survived to hospital discharge. Cardiac activity on US was the variable most associated with survival at all time points. On multivariate regression modeling, cardiac activity was associated with increased survival to hospital admission (OR 3.6, 2.2-5.9) and hospital discharge (OR 5.7, 1.5-21.9). No cardiac activity on US was associated with non-survival, but 0.6% (95% CI 0.3-2.3) survived to discharge. Ultrasound identified findings that responded to non-ACLS interventions. Patients with pericardial effusion and pericardiocentesis demonstrated higher survival rates (15.4%) compared toall others (1.3%). Conclusion: Cardiac activity on ultrasound was the variable most associated with survival following cardiac arrest. Ultrasound during cardiac arrest identifies interventions outside of the standard ACLS algorithm. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

引用

页码：33 / 39

页数：7

共 29 条

[1] CARDIAC MOVEMENT IDENTIFIED ON PREHOSPITAL ECHOCARDIOGRAPHY PREDICTS OUTCOME IN CARDIAC ARREST PATIENTS [J].