Current CPR guidelines recommend performing POCUS-CA when a reversible cause is suspected, although the impact on clinical outcomes is not yet clear. ĭuring cardiopulmonary resuscitation (CPR), the POCUS-CA in the in-hospital setting, prioritizing the emergency department and the ICU, is a protocol to consider in the diagnosis of reversible causes of cardiac arrest in patients with non-defibrillable rhythms (pulseless electrical activity and asystole), such as cardiac tamponade, pulmonary embolism, tension pneumothorax, and hypovolemia, as well as to distinguish true asystole from fine ventricular fibrillation, conditions that have opposed therapeutic approaches. It also provides prognostic information regarding the possibility of a return to spontaneous circulation (ROSC) and survival. The point of care ultrasound in cardiac arrest (POCUS-CA) conducted by a trained clinician allows the evaluation of the quality of the compressions, the quick diagnosis of reversible causes of arrest with non-defibrillable rhythms, the monitoring interventions, and its response to treatment. Ultrasound is a diagnostic tool at the bedside of the patient that has been studied in the context of the patient in out and in-hospital arrest, and its importance has been suggested to be included in Advanced Cardiac Life Support (ACLS) algorithms. These therapy bases lay the foundation for other possible interventions, such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post-cardiac arrest care, including targeted temperature control, cardiorespiratory support, and percutaneous coronary intervention. The basis for cardiac resuscitation includes the immediate provision of high-quality cardiopulmonary resuscitation combined with early defibrillation for defibrillable rhythms to impact the outcomes positively. Cardiac arrest is frequently the result of noncardiac disorders of respiratory, hemodynamic, or neurological origin that cause a critical decrease in myocardial oxygenation, causing a reduction in contractility that culminates in pulseless electrical activity and ultimately asystole. The mechanisms of cardiorespiratory a16 jrrest differ between out and in-hospital since in-hospital cardiac arrest is frequently the result of clinical deterioration, which typically occurs gradually for hours or days in the context of a critically ill patient. Around 209,000 in-hospital cardiac arrests occur in adults each year in the United States, with an average survival of 24.8% and survival to discharge from hospital of 11.4%. After cardiac arrest, the survival at hospital discharge is approximately 10.4%, and survival with good functional status is 8.4%. According to the American Heart Society's recent Heart and Stroke Statistics report, 90% of them are fatal. It is estimated that more than 356,000 out-of-hospital cardiac arrests occur annually in the United States of America. If the attempts are unsuccessful, it is known as sudden cardiac death. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.Ĭardiac arrest is the cessation of mechanical cardiac activity, as confirmed by the absence of circulation, and sudden cardiac arrest is an unexpected cardiac arrest that could result in attempts to restore circulation. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting.
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