Utility of Point-of-Care Ultrasound for In-Hospital Cardiac Arrest

Abstract

SESSION TITLE: Rapid Session: Bedside Imaging SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 07:30 AM - 08:30 AM PURPOSE: The objective in management of patients experiencing cardiac arrest is to identify reversible causes. The introduction of Point-of-Care Ultrasound (POCUS) into critical care has opened avenues not previously available in the management of these patients. We aimed to observe the effects of introduction of POCUS in management of patients experiencing in-hospital cardiac arrest (IHCA). IHCA has been reported to have a survival rate of 6.6% to hospital discharge. While multiple protocols exist for intra-arrest echocardiography, a recent meta-analysis of 15 studies examining POCUS in cardiac arrest consisted entirely of pre-hospital and/or Emergency Department settings. This is the first study examining the impact of POCUS on IHCA. METHODS: We collected a convenience sample of 19 patients with IHCA between July 2016 and February 2017 who had a POCUS performed as part of their management due to critical care fellow availability. In our tertiary-care urban community teaching hospital, we have ultrasound-trained critical care fellows and faculty. In general, we would perform POCUS in cases where a second fellow would be available to perform and interpret the exam since the primary fellow would be involved with other aspects of patient care during cardiac arrest. RESULTS: Out of 75 total IHCA at our institution during the study period, 24 occurred during times when 2 fellows would normally be present and were announced overhead. 15 of our studies occurred during this time period (4 occurred outside of this time period), yielding 63% of potential IHCA patients underwent POCUS. Average age of patients was 67.7 years and 52.6% of them were male. 47.4% of arrests occurred in the medical ICU and PEA was the initial rhythm in 73.7% of patients. Average time of CPR was 16.1 minutes (Range 4-37) and 73.7% of patients achieved ROSC. All patients had goal-directed echocardiography including, at minimum, a subcostal view. 5.3% of patients (1/19) received tPA due to severe RV dysfunction. One patient had a small IVC diameter and therefore received IV Fluids. All patients who were checked for lung sliding had lung sliding present and therefore pneumothorax was ruled out as a cause of cardiac arrest. No pericardial effusions were noted and therefore cardiac tamponade was ruled out as a cause of cardiac arrest. LV function was found to be normal or hyperdynamic in 6 patients, all of whom achieved ROSC. CONCLUSIONS: POCUS is feasible and useful in management of patients experiencing in-hospital cardiac arrest. CLINICAL IMPLICATIONS: POCUS should play a larger role for IHCA in hospitals which have that capability. Future studies should focus on larger patient population and potential use of POCUS in assessing efficacy of compressions by examining real-time surrogate markers of stroke volume. DISCLOSURE: The following authors have nothing to disclose: Eric Bondarsky, Lina Miyakawa, Angela Love, Paru Patrawalla, Samuel Acquah, Young Im Lee No Product/Research Disclosure Information