Journal ArticleDOI
Detection of Pulmonary Embolism During Cardiac Arrest-Ultrasonographic Findings Should Be Interpreted With Caution.
Rasmus Aagaard,Philip Caap,Nicolaj C. Hansson,Morten Thingemann Bøtker,Asger Granfeldt,Bo Løfgren +5 more
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TLDR
The right ventricle was more dilated during resuscitation when cardiac arrest was caused by pulmonary embolism compared with hypoxia and primary arrhythmia, and these findings challenge the paradigm that right ventricular dilatation on ultrasound during cardiopulmonary resuscitation is particularly associated with pulmonary emblism.Abstract:
OBJECTIVES The aim of this study was to test the hypothesis that the right ventricle is more dilated during resuscitation from cardiac arrest caused by pulmonary embolism, compared with hypoxia and primary arrhythmia. DESIGN Twenty-four pigs were anesthetized and cardiac arrest was induced using three different methods. Pigs were resuscitated after 7 minutes of untreated cardiac arrest. Ultrasonographic images were obtained and the right ventricular diameter was measured. SETTING University hospital animal laboratory. SUBJECTS Female crossbred Landrace/Yorkshire/Duroc pigs (27-32 kg). INTERVENTIONS Pigs were randomly assigned to cardiac arrest induced by pulmonary embolism, hypoxia, or primary arrhythmia. MEASUREMENTS AND MAIN RESULTS There was no difference at baseline. During induction of cardiac arrest, the right ventricle dilated in all groups (p < 0.01 for all). The primary endpoint was right ventricle diameter at the third rhythm analysis: 32 mm (95% CI, 29-36) for pulmonary embolism which was significantly larger than both hypoxia: 23 mm (95% CI, 20-27) and primary arrhythmia: 25 mm (95% CI, 22-28)-the absolute difference was 7-9 mm. Physicians with basic training in focused cardiac ultrasonography were able to detect a difference in right ventricle diameter of approximately 10 mm with a sensitivity of 79% (95% CI, 64-94) and a specificity of 68% (95% CI, 56-80). CONCLUSIONS The right ventricle was more dilated during resuscitation when cardiac arrest was caused by pulmonary embolism compared with hypoxia and primary arrhythmia. However, the right ventricle was dilated, irrespective of the cause of arrest, and diagnostic accuracy by physicians with basic training in focused cardiac ultrasonography was modest. These findings challenge the paradigm that right ventricular dilatation on ultrasound during cardiopulmonary resuscitation is particularly associated with pulmonary embolism.read more
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Journal ArticleDOI
The Right Ventricle Is Dilated During Resuscitation From Cardiac Arrest Caused by Hypovolemia: A Porcine Ultrasound Study.
Rasmus Aagaard,Asger Granfeldt,Morten Thingemann Bøtker,Troels Mygind-Klausen,Hans Kirkegaard,Bo Løfgren +5 more
TL;DR: In this paper, the authors compared the right ventricle diameter during resuscitation from cardiac arrest with other causes of cardiac events such as pulmonary embolism and cardiac failure, and they found that the degree of deformation was inherent to cardiac arrest rather than being associated with certain causes of death.
Journal ArticleDOI
Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival: Findings From the French National Cardiac Arrest Registry
François Javaudin,Jean-Baptiste Lascarrou,Quentin Le Bastard,Quentin Bourry,Chloé Latour,Hugo De Carvalho,Philippe Le Conte,Joséphine Escutnaire,Hervé Hubert,Emmanuel Montassier,Brice Leclère +10 more
TL;DR: In OHCA patients with confirmed PE and admitted with recuperation of spontaneous circulation in the hospital, there was significantly higher 30-day survival in those who received thrombolysis during CPR compared with patients who did not receive throm bolysis.
Journal ArticleDOI
Extracorporeal membrane oxygenation in life-threatening massive pulmonary embolism:
Benedict Kjærgaard,Jens Hedegaard Kristensen,Jesper Eske Sindby,Susanne de Neergaard,Bodil Steen Rasmussen +4 more
TL;DR: The treatment of thrombolytic medications in massive PE is risky, but if the patient is treated or prepared for ECMO, it can be lifesaving, it seems reasonable to build up a PE alert team with ECMO capability to take care of patients with massive PE.
Journal ArticleDOI
Bedside ultrasound in cardiac standstill: a clinical review
TL;DR: Despite the increasing evidence surrounding ultrasound use in arrest, bedside ultrasound is still largely underutilized during the resuscitation process, and its utility in predicting worse survival outcomes in patients with cardiac standstill is of note.
Journal ArticleDOI
Decision-making in cardiac arrest: physicians' and nurses' knowledge and views on terminating resuscitation.
TL;DR: One-third of all physicians did not feel competent to decide when to terminate CPR, physicians' and nurses' knowledge of termination guidelines was poor, and both professions reported unvalidated or controversial factors as a single reason for terminating CPR.
References
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Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography
Lawrence G. Rudski,Wyman W. Lai,Jonathan Afilalo,Lanqi Hua,Mark D. Handschumacher,Krishnaswamy Chandrasekaran,Scott D. Solomon,Eric K. Louie,Nelson B. Schiller +8 more
TL;DR: The Society of Echocardiography (SEDC) is an educational activity for cardiovascular physicians and cardiac sonographers with a knowledge base in the field of echo-cardiography as discussed by the authors.
Journal ArticleDOI
Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography
Lawrence G. Rudski,Wyman W. Lai,Jonathan Afilalo,Lanqi Hua,Mark D. Handschumacher,Krishnaswamy Chandrasekaran,Scott D. Solomon,Eric K. Louie,Nelson B. Schiller +8 more
TL;DR: This activity is designed for all cardiovascular physicians and cardiac sonographers with arest and knowledge base in the field of echocardiography and reschers, clinicians, intensivists, and other medical professionals with a spein cardiac ultrasound will find this activity beneficial.
Journal ArticleDOI
European Resuscitation Council Guidelines for Resuscitation 2010 Section 4 Adult advanced life support
Charles D. Deakin,Jerry P. Nolan,Jasmeet Soar,Kjetil Sunde,Rudolph W. Koster,Gary B. Smith,Gavin D. Perkins +6 more
TL;DR: Cardiothoracic anesthetic, Southampton General Hospital, Southampton, UK Anesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK Anaesthesia and intensive care medicine, Southmead Hospital, Bristol, UK Surgical ICU, Oslo University Hospital Ulleval, Oslo, Norway Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands Critical Care and Resuscitation, University of Warwick, Warwick Medical School, Warwick, UK
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Part 4: Advanced life support: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
Jerry P. Nolan,Mary Fran Hazinski,Richard Aickin,Farhan Bhanji,John E. Billi,Clifton W. Callaway,Maaret Castrén,Allan R. de Caen,Jose Maria E. Ferrer,Judith Finn,Lana M. Gent,Russell E. Griffin,Sandra Iverson,Eddy Lang,Swee Han Lim,Ian Maconochie,William H. Montgomery,Peter T. Morley,Vinay M. Nadkarni,Robert W. Neumar,Nikolaos I. Nikolaou,Gavin D. Perkins,Jeffrey M. Perlman,Eunice M. Singletary,Jasmeet Soar,Andrew H. Travers,Michelle Welsford,Jonathan Wyllie,David Zideman +28 more
TL;DR: The International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies and using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.
Journal ArticleDOI
Right Ventricular Function in Cardiovascular Disease, Part I Anatomy, Physiology, Aging, and Functional Assessment of the Right Ventricle
TL;DR: The goal of the present review is to offer a clinical perspective on RV structure and function, using echocardiography and magnetic resonance imaging to create new opportunities for the study of RV anatomy and physiology.