Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

Abstract

Background: Guidelines emphasize the clinician to consider the use of ultrasound to determine the cause of cardiac arrest. In this study we aimed to investigate how focused cardiac ultrasound (FOCUS) shortly after return of spontaneously circulation (ROSC) was associated with the use of further diagnostic measures and if the detection of pulmonary embolism, cardiac tamponade and acute myocardial infarction could be improved.

Methods: A retrospective, single-center, observational study at a tertiary hospital to evaluate FOCUS performed by cardiologists within 60 min after ROSC. Included were adult cardiac-arrest patients with ROSC, without restrictions in care. Excluded were patients with ECGs demonstrating ST elevation, patients with an obvious non-cardiac cause of cardiac arrest and patients where FOCUS was not performed.

Results: Between January 2012 and December 2017, FOCUS was performed in 237 (182 OHCA and 55 IHCA) patients. FOCUS findings influenced management and led to further immediate diagnostic measures in 52 (21.9%) patients. Left-ventricular regional wall motion abnormalities influenced the decision to perform emergency coronary angiography in 17 (7.2%) patients, of which nine were treated with PCI. Right-ventricular dilatation and/or pressure overload influenced a decision to perform computerized tomography of the thorax in 21 (8.9%) patients, of which 11 were diagnosed with pulmonary embolism. Cardiac tamponade was found in three patients (1.2%).

Conclusion: The retrospective data on this cardiac-arrest population supports that ALS-conformed post-resuscitation care could include FOCUS as an adjunctive diagnostic measure shortly after ROSC.

Keywords: Cardiac arrest; Focused cardiac ultrasound.