MEDEST - July 17, 2018
"In a recent trial (Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial link in the references) evaluating the use of POCUS in extreme shock and cardiac arrest in prehospital setting the investigators found that, examining with ultrasound patients in cardiac arrest, 74,5% and 35% of PEA and Asystole respectively had cardiac wall motion and a rate of survival significatively higher than “no cardiac activity patients” (55% vs 8% in PEA and 24% vs 11% in Asystole)...
Take home points about pseudo PEA:
- ALWAYS use ultrasound to determine cardiac activity in cardiac arrest patients
- Don’t trust central pulse palpation
- Pseudo PEA is an ultrasound evident cardiac activity without carotid pulse
- Pseudo PEA is a big clinical reality beyond ACLS mantras
- Use ultrasound to look for reversible causes of pseudo PEA.
- Use waveform EtCO2 and waveform Pulse Oximetry to monitor perfusion
- Continue CHEST COMPRESSIONS in pseudo PEA with bad perfusionstate indicators:
- Wide bradycardic electric activity
- Low EtCO2 (below 20 mmHg)
- No waveform on Pulse ox
- Use VASOPRESSORS in pseudo PEA with good perfusion state indicators:
- Narrow normofrequent electric activity
- EtCO2 above 35-40
- Good waveform on Pulse ox