REBEL Cast Ep57 – July 25, 2018 - By Kevin Gardner
..."Step 1: According to the authors pericardial effusion causing cardiac tamponade is the cause of cardiac arrest in 4 – 15% of patients. Tamponade can be intervened upon with the use of pericardiocentesis.
Step 2: The authors state that, pulmonary embolism is the cause of cardiac arrest in 4.0 – 7.6% of patients. Evidence of right heart strain, should place pulmonary embolism higher in the differential, but there can be other causes of right heart strain. If PE is diagnosed, systemic thrombolysis is recommended.
Step 3: Finally, the authors state that the presence of absence of cardiac activity can provide useful prognostic information. Obviously the absence of cardiac activity in PEA portends worse outcomes (survival to hospital discharge rate = 0.0% – 0.6%). This finding along with other poor prognostic factors such as low end-tidal CO2, prolonged downtime, and unwitnessed arrest can help in the utility of ongoing resuscitation.
Ancillary Steps: Tension pneumothorax is a rare cause of non-traumatic cardiac arrest, but can be assessed by absence of lung sliding on POCUS in the anterior chest. If detected, needle decompression or finger/tube thoracostomy may be considered
Author Conclusion: “The CASA exam assesses for the highest yield reversible causes of PEA that can be visualized with ultrasound, while limiting POCUS’s negative impact.”"