Journal: Chinese Journal of Traumatology
Title: Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest.
Authors: Chardoli M, Heidari F, Rabiee H, Sharif-Alhoseini M, Shokoohi H, Rahimi-Movaghar V.
Date: 2012
Design: Prospective interventional study, patients presenting with PEA arrest were randomized into two groups.
- Group A, trained emergency physicians performed echocardiography.
- Group B underwent ACLS protocol without echocardiography
Measures: Evaluated cardiac activity, right ventricle dilation, left ventricle function, pericardial effusion/tamponade and IVC size. The presence or absence of mechanical ventricular activity (MVA) and evidence of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC) and death were evaluated in both groups.
Results:
100 patients enrolled (50 in Group A, 50 in Group B)
The resuscitation outcomes for PEA arrest patients with/without cardiac activity on ResUS are described in Table 1
The resuscitation outcomes for PEA arrest patients with/without cardiac activity on ResUS are described in Table 1
Importantly: The presence
of ventricular activity had 43% positive predictive
value for ROSC. The absence of ventricular activity had
100% positive predictive value for
death
The authors noted:
"ROSC was recorded in 17 (34%) and 14 (28%) patients in Groups A and B, respectively. However, resuscitation results did not indicate any significant difference between the two groups (P=0.52, power=0.06)"
"ROSC was recorded in 17 (34%) and 14 (28%) patients in Groups A and B, respectively. However, resuscitation results did not indicate any significant difference between the two groups (P=0.52, power=0.06)"
Commentary:
The only randomized trial of ResUS cited by AHA 2015 guidelines in support of ResUS during CPR. ResUS "may be considered during
the management of cardiac arrest, although its usefulness has
not been well established (Class IIb, LOE C-EO)".
- This study demonstrates no survival benefit in patients receiving ResUS.
- A qualified sonographer needs to be present
- ResUS should not interfere with the standard treatment.
- No cardiac activity = death
Small number of cases, single center, More (large scale) studies are needed!
Posted by: A Adedipe, MD
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