Emergency Medicine Mon 29 May 2023 Echocardiography for prognostication during the resuscitation of cardiac arrest patients with non-shockable rhythm
Keywords :  ResuscitationUltrasoundCardiacArrestPea 
Researcher : Suku lethika akhil
Research Guide : Radhakrishnan chandni
Institution Name : Government medical college kozhikode


INTRODUCTION: Globally Incidence of sudden cardiac arrest is increasing due to raise in various comorbidities and other causes like trauma. Resuscitation done in both OHCA and IHCA victims focusses on various time dependent and sensitive interventions. Resuscitation ultrasound is a subgroup of point-of-care ultrasound (POCUS) procedures to improve resuscitation efforts by identifying reversible causes of cardiac arrest and can be used for prognosticating the cardiac arrest victims. OBJECTIVES To compare the patients in cardiopulmonary arrest with non shockable rhythm having myocardial contractility in Transthoracic echocardiography (TTE) with that of patients having no myocardial contractility in TTE in terms of Return of spontaneous circulation (ROSC) attained initially, upto 24 hrs and survive to hospital discharge. To find and treat reversible causes of cardiac arrest during cardiopulmonary arrest using FEEL protocol To quantify meaningful myocardial contractility in terms of wall motion and valvular motion during cardiac arrest using TTE METHODS Prospective observational cohort study done in both Out of hospital cardiac arrest (OHCA) victims brought to Emergency department (ED) of Government Medical college Kozhikode and In hospital cardiac arrest (IHCA) victims in ED and EDICU of the same hospital. Study is conducted with a sample size of 250.study period was from December 2019 to September 2021.Using FEEL (the Focussed Echocardiography Examination in Life) protocol sonographic images are obtained exclusively during the brief breaks from cardiac compressions for rhythm analysis and pulse check. Faculties of Emergency medicine department performed the TTE.The images obtained during study was subsequently evaluated by cardiologist. ROC curve was generated to assess the accuracy of EPSS in prognosticating ROSC. Data was entered using excel and analysed with Stata version 14.0. RESULTS Out of 250 participants,18.4% had OHCA, while the rest being IHCA victims. 81% of study participants were identified within 10 sec of cardiac arrest event with most of them being IHCA victims. (85%) had pulseless electrical activity as initial rhythm while 15% had asystole as initial rhythm. The presence of cardiac activity on TTE was associated with 4.67 times greater chance of having return of spontaneous circulation (ROSC) compared to those without a cardiac activity. The presence of cardiac activity was significantly associated with increased survival at hospital discharge compared to those without cardiac activity (p value <0.001). Reversible causes were present in 12% study participants and for all of them the reversible causes were corrected. Among the reversible causes detected majority were Hypovolemia and pneumothorax. Male gender (RR 1.5), IHCA (RR 1.5), <10 secs of unresponsiveness (RR 1.7) and presence of trauma (RR 1.7) had more chances of having cardiac activity present when compared to their counterparts. Presence of comorbidities like CAD, Type 2 DM, HTN, CVA and CKD were significantly associated with reduced chance of having a cardiac activity at initial presentation as indicated by univariate analysis. The curve and corresponding AUC show that End point septal separation (EPSS) value of >=4 has good ability to detect non ROSC among subjects. CONCLUSION: TTE can be effectively utilized as a useful tool in the prognostication of CPA victims having a Non-shockable rhythm with myocardial contractility and without myocardial contractility. TTE can be effectively used for assessing the reversible causes of cardiac arrest victim. EPSS can be used as one of the criteria for assessing the cardiac contractility during resuscitation in cardiac arrest victims and further studies are needed in this aspect.

DOI: 1685346940   Year of publication: 2022

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