From the Guidelines
The use of Point of Care Ultrasound (POCUS) during cardiac arrest is not recommended as a routine practice, but it may be considered as an additional diagnostic tool when clinical suspicion for a specific reversible cause is present and can be performed by experienced personnel without interrupting CPR. When considering the implementation of POCUS in cardiac arrest, it is crucial to weigh the potential benefits against the risks of interrupting chest compressions and misinterpreting sonographic findings 1. The decision to use POCUS should be made on a case-by-case basis, taking into account the clinical context and the potential for POCUS to identify reversible causes of cardiac arrest, such as cardiac tamponade or massive pulmonary embolism 1. Some key points to consider when using POCUS in cardiac arrest include:
- The examination should be brief and performed during a planned pause in chest compressions to minimize interruptions in CPR.
- The ultrasound probe should be placed in the subxiphoid view first, with parasternal long axis as an alternative if the subxiphoid view is inadequate.
- The examination should be performed by a trained provider who can acquire and interpret images quickly.
- POCUS should complement, not replace, standard ACLS protocols and should not cause prolonged interruptions in chest compressions, which could worsen outcomes. It is essential to note that the evidence for the use of POCUS in cardiac arrest is limited, and the diagnostic utility of POCUS is affected by the clinical context 1. Therefore, the use of POCUS in cardiac arrest should be approached with caution and only considered when the potential benefits outweigh the risks.
From the Research
Cardiac Arrest POCUS Protocol
The recommended Point of Care Ultrasound (POCUS) protocol in cardiac arrest involves several key applications, including:
- Assessing cardiac activity and identifying potential reversible causes of arrest, such as pericardial effusion or pneumothorax 2, 3
- Guiding interventions like central line placement or pericardiocentesis 2, 4
- Providing real-time feedback on the effectiveness of resuscitation efforts 2, 5
- Evaluating the quality of compressions during cardiopulmonary resuscitation (CPR) 3
- Defining prognosis of survival according to specific findings 3
POCUS Protocols in Cardiac Arrest
Several frameworks organize and direct POCUS during cardiac arrest, although many are proofs of concept and require further evaluation 6, 5. The use of POCUS in cardiac arrest is advocated by all resuscitation guidelines, highlighting its prognostic, diagnostic, and forensic potential 2. However, its limitations and challenges, such as the potential for interruption of chest compressions during image acquisition and operator proficiency, should be considered 2, 6.
Diagnostic and Prognostic Aid
POCUS offers better specificity than sensitivity as a diagnostic aid in cardiac arrest, and its prognostic accuracy is better characterized but subject to unique biases and confounding 6. POCUS findings can indicate a particular diagnosis or encourage the continuation of resuscitation, but the absence of findings is not sufficient in isolation to exclude a particular diagnosis or cease resuscitation 6, 3.