Effectiveness of the use of ultrasound in patients with non-traumatic cardiopulmonary arrest

OBJECTIVE: The aim of the present study was to evaluate the effectiveness of cardiac ultrasound (USG) in the diagnosis of non-traumatic cardiopulmonary resuscitation and orient the resuscitation in the emergency department. MATERİALS AND METHODS: This was a prospective study conducted in 179 patients, aged over 16 years, for whom cardiac USG was used during cardio-pulmonary resuscitations performed between January 2013 and December 2015 in the emergency department of Gaziantep University, Turkey. Cardiac USG application was performed (apical, subxiphoid, and parasternal window) by two experienced doctors who had participated in an emergency cardiac USG course. Logiq P6 (GE Healthcare, 2008) was used for evaluation. When the patients were taken to the first resuscitation room, USG evaluation, measuring of pulse, and monitoring of status were simultaneously carried out. The doctor who conducted the USG had not been a member of the resuscitation team. SPSS 18.0 was used for statistical analysis. RESULTS: A total of 179 patients who fulfilled the inclusion criteria were included in the study. Of the cardio-pulmonary arrests (CPA), 63.7% (n=114) occurred outside the hospital, and 36.3% (n=65) occurred in the emergency department. The average age of the patients was 62.8 ± 16.4 years (range, 19-85 years). On initial assessment, 7.3% (n=13) patients had a femoral pulse, while 92.7% (n=166) did not. Monitoring showed that while 29.7% (n=53) of patients had a regular rhythm, 60.3% (n=108) had an irregular rhythm. A total of 10% (n=18) of patients had ventricular fibrillation. USG determined cardiac rhythm and ventricular fibrillation in 14.6% (n=26) and 7.8% (n=14) of patients, respectively, and cardiac rhythm was not observed in 77.7% (n=139) of patients. In spontaneous evaluation with USG, 75 patients had asystole, 33 patients had myocardial contraction, 24 patients had only valvular movements, 14 patients had ventricular fibrillation (VF), 13 patients had normal cardiac activity, seven patients had pericardial tamponade, four patients had right ventriculer dilatation, four patients had global hypokinesia, four patients had hypovolemia, and one patient had aortic dissection. A total of 10 of the 14 patients with VF and three of 75 patients with asystole were discharged from hospital with healing. In the first evaluation, 42 patients were considered to have had pulseless electrical activity (PEA); in fact, the ultrasound evaluation showed that 13 of these were cases of false PEA. Similarly, in the second evaluation, 32 patients were considered to have had PEA but in reality14 of these were cases of false PEA. CONCLUSION: The use of cardiac USG during CPR will provide a major contribution to the resuscitation team in the issues of identifying PEA types, determining the probable causes of arrest, selecting an appropriate treatment and terminating the resuscitation process. The use of cardiac USG integrated to the ACLS protocol will provide great benefits. KEYWORDS: Cardiopulmonary arrest, cardiopulmonary resuscitation, cardiac ultrasound, pulseless electrical activity.