Ultrasound Use During Cardiopulmonary Resuscitation is Associated with Delays in Chest Compressions: Huis in’t Veld MA, Allison MG, Bostick DS, et al. Resuscitation. 2017; 119: 95-98

Abstract

The goal of cardiopulmonary resuscitation (CPR) is to maintain coronary perfusion pressure (CPP) in patients in cardiopulmonary arrest. Advanced cardiac life support (ACLS) teaches us that high-quality chest compressions – depth of 5cm, rate of 100/min, with limited interruptions – are the key to maintaining CPP. With this in mind, it is unclear what role, if any, frequently performed adjuncts such as point of care ultrasound (POCUS) should have during the delivery of CPR. The goal of this study was to investigate the impact of POCUS on pulse check duration during CPR performed on adults in cardiac arrest treated in the emergency department (ED). This prospective cohort study was conducted in an urban emergency department (ED) between August 2015 and September 2016. Eligible patients included all patients over the age of 18 who presented to the ED in cardiac arrest or in whom cardiac arrest occurred while they were in the ED in one of three resuscitation rooms equipped with video monitoring equipment. Researchers then reviewed the recorded resuscitations and documented the duration of pulse checks and whether POCUS was employed during pulse check. A linear mixed-effects model was used to assess the effect of POCUS on the duration of pulse checks. Twenty-three patients were enrolled in the study with a total of 123 pulse checks. The mean duration of pulse checks without POCUS was 13 seconds (95% confidence interval (CI) 12-15). This increased to 21 seconds (95% CI 18-24) when POCUS was performed. Therefore, the use of POCUS increased the duration of pulse checks by 8.4 seconds (95% CI 6.7-10). The authors of this study concluded that the use of POCUS during CPR was associated with a significant increase in the duration of pulse checks, nearly doubling the 10-second duration recommended in current ACLS guidelines. They further iterate that should providers perform POCUS during resuscitation, it is incumbent upon them to pay close attention to time spent between administrations of quality compressions. Comment: Although physiologically it is clear that prolonged intervals between quality chest compressions will result in decreased coronary perfusion pressures and therefore poorer outcomes; this study was too small to show any effect on patient outcomes. For now, more research is required to determine whether the potential benefits of POCUS during cardiac arrest resuscitations outweigh its delay in high quality compressions. In the meantime, as ED providers, we must remain diligent in minimizing interruptions to chest compressions by developing strategies for performing adjuncts such as POCUS within the confines of the standard 10-second pulse check.