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viernes, 9 de diciembre de 2016

POCUS in Cardiac Arrest

R.E.B.E.L. EM - Emergency Medicine Blog
R.E.B.E.L.EM - December 8, 2016 - By Salim Rezaie
"Background: For many emergency providers, POCUS has become a critical modality in the resuscitation of patients with cardiac arrest. The authors of this paper (The REASON Trial) state that <8% of all OHCA’s survive to hospital discharge; a dismal number. We already know that shockable rhythms, early defibrillation, early bystander CPR, and ROSC in the field are all associated with increased survival. What we don’t have is large scale evidence that the use of POCUS improves survival with good neurologic outcomes.
Clinical Question: Is detection of cardiac activity on POCUS in patients with PEA or asystole associated with improved survival from cardiac arrest?...
Author Conclusion: “Cardiac activity on ultrasound was the variable most associated with survival following cardiac arrest. Ultrasound during cardiac arrest identifies interventions outside of the standard ACLS algorithm.”
Clinical Take Home Point: The use of bedside ultrasound in PEA/Asystolic cardiac arrest can help identify pathologies that require a specific intervention, used as an adjunct to discontinue resuscitation efforts, and identify cardiac activity that is not appreciated with traditional finger pulse checks. It is unclear from this study whether the use of bedside ultrasound in cardiac arrest is an intervention that improves neurologically intact outcomes."