Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers.
Cardiac arrest presenting as pulseless electrical activity (PEA) currently has a very low survival rate. Many of the conditions underlying PEA (cardiac tamponade, hypovolemia, and pulmonary embolus) are associated with specific cardiac ultrasound findings. The aim of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained nonexpert sonographers integrated into the ACLS response system at a major medical center.


METHODS
An emergency sonography system was created and deployed to each inpatient cardiac arrest occurring at Dartmouth Hitchcock Medical Center between November 1, 2003 and April 30, 2004. Thirteen internal medicine house officers received training to perform a limited subcostal cardiac ultrasound examination designed to diagnose cardiac tamponade, pulmonary embolus, severe hypovolemia, and lack of cardiac motion. Time from arrest alert to sonographic result, and correlation with over-reading by blinded echocardiography physicians were assessed.


RESULTS
A complete emergency ultrasound examination was performed in five PEA arrests. The average time from arrest alert to interpretation was 7.75 min. (95% CI 2.8-18.3 min). Three of these examinations (60%, 95% CI 14.7-94.7%) were adequate for interpretation. Agreement between the nonexpert sonographer and echocardiography physician occurred in four of five (kappa=0.706) cases.


CONCLUSIONS
Rapid cardiac sonography can be successfully integrated in the ACLS response. Nonexpert sonographers may be able to provide useful interpretive information when sufficiently trained.
Niendorff
Daniel F
DF
Department of Anesthesiology, Dartmouth Hitchcock Medical Center, USA. niendd@kadlecmed.org
Rassias
Athos J
AJ
Palac
Robert
R
Beach
Michael L
ML
Costa
Salvatore
S
Greenberg
Mark
M
D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D002305:Cardiac Tamponade / Q000150:complications / Q000000981:diagnostic imaging; D016887:Cardiopulmonary Resuscitation; D002983:Clinical Competence; D016638:Critical Illness; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D007297:Inpatients; D008021:Life Support Systems; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging; D011787:Quality of Health Care; D018570:Risk Assessment; D014481:United States; D014693:Ventricular Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy