Detection of traumatic complications of cardiopulmonary resuscitation by ultrasound

Study objective: We conducted a pilot study to assess the feasibility of ultrasonography in the detection of traumatic complications of CPR. Methods: A prospective case series was undertaken with a convenience sample of 21 emergency department patients who sustained nontraumatic cardiopulmonary arrest. A 5- to 7-minute ultrasound examination was performed during resuscitation. The presence or absence of free fluid was noted in the left and right upper quadrants, coronal views of the kidneys, the pelvis, and the pericardium; autopsies to determine the source of fluid were not performed. Cardiac activity and the concurrent electrical rhythm were also noted. All ultrasonographers had previously been trained in the use of this technique for the evaluation of trauma patients. Examinations were stored on videotape for further review. Results: Seven of 20 patients (29%) had findings on ultrasound that could have resulted from CPR-related trauma. in one additional case, findings of free fluid were probably the result of preexisting illness (ascites). Pericardial effusion was found in three patients, perihepatic fluid in four, pleural fluid in one, perirenal fluid in four, perisplenic fluid in two, and pelvic fluid in three; several patients had multiple findings. Cardiac motion with pulseless electrical activity was noted in seven patients. Five patients had return of spontaneous circulation and survived to hospitalization, and one survived to discharge. Conclusion: Traumatic complications of CPR are well known but typically difficult to assess. Ultrasonography may identify injuries, help guide procedures, and serve as a means to assess pharmacologic effects on cardiac performance during CPR. It is a readily available, noninvasive means to assess these critically ill patients.