300 Focused Cardiac Sonography During Resuscitation of Cardiac Arrest Patients in the Emergency Department

Abstract

Study Objective: Focused sonography may be considered an extension of the physical examination as it allows accurate and rapid recognition of critical conditions. Multiple studies have shown evidence that focused cardiac sonography is a feasible adjunct to cardiopulmonary resuscitation. This study, which is the first known research on this topic in the Philippines, investigated the utility of cardiac sonography performed by emergency physicians to predict the resuscitation outcomes of cardiac arrest patients. The study likewise aimed to determine the utility of ultrasound to direct the management of patients in cardiac arrest and to determine the possible etiology of the arrest. Methods: This is a prospective cohort study which included a convenience sample of cardiac arrest patients seen in the emergency department during the 11-month study period. These patients underwent focused cardiac sonography through the subxiphoid view at the end of each 2-minute cycle during resuscitation. The presence of cardiac activity as well as the possible etiology of the arrest was also noted. End points analyzed as possible predictors of resuscitation included patients' clinical profile, pre hospital transit time, presenting cardiac rhythm, cardiac activity on sonography, and length of emergency department (ED) resuscitation. Data were then analyzed through MEDCALC and SPSS. Results: A total of 53 patients were included in the study. The results showed that cardiac activity when correlated to return of spontaneous circulation, 24-hour survival and survival to hospital discharge has a sensitivity of 59.1, 66.7 and 50, respectively while the specificity was 64.5, 59.1, and 54.9 accordingly. The negative predictive value for all clinical outcomes was higher than the positive predictive value suggesting that the absence of cardiac activity is a poor prognosticating factor. Among the other patient factors analyzed, number of arrests and transit time were the only variables significantly associated with survival. No possible etiology of the arrest was seen in all 53 patients. Nineteen patients were found to be in PEA but with presence of cardiac activity on ultrasound. Three of these 19 patients were given Atropine and inotropes and all 3 patients achieved return of spontaneous circulation. Conclusion: Although there was no possible etiology of the arrest seen in all patients, this data is important to narrow the differential diagnosis. In addition, the use of inotropes, as the results showed, may be considered in patients found to be in pseudo PEA. Although, the absence of cardiac activity is associated with a poor outcome of resuscitation, it is important that other patient factors are considered. Ultimately, the management of each cardiac arrest patient is unique and dependent on the emergency physician's clinical judgment.