Ultrasound in Cardiac Arrest

This week's image of the week is brought to us by Drs. Taj Adams and Mikaela Chilstrom, who used ultrasound to confirm cardiac standstill during CPR. The finding of "echocardiographic asystole" on intial ED echo was shown in a small study by Blaivas and Fox to have a positive predictive value of 100% for death in the ED and a negative predictive value of 58%. Further larger studies are needed, but many providers use ultrasound as one of many tools to guide resuscitation efforts. "Echocardiographic asystole" will appear as the absence of myocardial contractions. The exam should be performed for the duration of a pulse check to ensure that slow cardiac activity is not missed. In this patient you can see that he blood in heart is not black but a similar echogenisty to the surrounding muscle suggesting a prolonged down time and clot formation.



Fine fibrillation can be seen in the video below.



In code situations don't forget the US can be an valuable tool in your PEA algorithm to assess for pericardial effusion, pneumothorax, right heart strain suggesting massive pulmonary embolus, or to find underlying causes of hemorrhagic shock such as abdominal aortic aneurysm, or hemoperitoneum.
Happy Scanning!

Blaivas, Michael. Fox, C. Outcome in Cardiac Arrest Patients Found to Have Cardiac Standstill on the Bedside Emergency Department Echocardiogram. ACADEMIC EMERGENCY MEDICINE • June 2001, Volume 8, Number 6.