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Mar 22 13 tweets 7 min read
It's #ResusciTuesday and today we discuss about the use of point-of-care ultrasound (POCUS) during Cardiopulmonary Resuscitation with @NatasaSpr
#ResusciTuesday #ResusTwitter #ERC #RESUS22 #FOAMed #POCUS
@NatasaSpr POCUS has been adopted by many physicians over the past decades and has been integrated in CA algorithms for the detection and treatment of reversible causes such as pneumothorax and cardiac tamponade. Many different protocols have been proposed. (Anesthesiology 2021;135:508–519) Image
@NatasaSpr Pearls and Pitfalls
❌Right Ventricular dilation during CA: In isolation should not be used to diagnose massive PE. It is observed minutes after CA as blood shifts from systemic circulation to the right heart, probably as a result of hypovolaemia, hyperkalaemia and arrhythmia.
@NatasaSpr ❌Delays in chest compressions: Huis in’t Veld et al showed that use of POCUS significantly increase rhythm check pauses (Resuscitation 2017;119:95-98)
✔️Do not cause prolonged interruptions in chest compressions
✔️Use the most experienced sonographer other than team leader
@NatasaSpr ✔️Prepare the machine (probe/depth/gain)
✔️Perform one window/pause
✔️Record a clip to review later
✔️Assign a timekeeper

acep.org/emultrasound/n… Image
@NatasaSpr ❓What about pulse detection?
According to ALS algorithm, return of spontaneous circulation (ROSC) is detected based on rhythm check and central pulse palpation during a 2-second pause. Nevertheless, the accuracy of manual pulse detection varies greatly (63% to 94%).
@NatasaSpr In a recent study by Cohen et al, femoral artery doppler ultrasound demonstrated higher accuracy than manual palpation for detection of any pulse (95.3% vs. 54.0%; p < 0.001). (Resuscitation - Published online: February 3, 2022)
@NatasaSpr Prognostication: PEA vs pseudo-PEA
PEA is defined as organized rhythm with neither palpable pulse nor cardiac contractility on POCUS. Pseudo-PEA has an organized rhythm on ECG and preserved cardiac contractility on POCUS, although not enough to generate pulse.
@NatasaSpr But why do we care? According to a recent meta-analysis, pseudo-PEA has +LR of ROSC (6.87) and increased odds of overall survival(Resuscitation 2019;139:159–66) Which means that POCUS findings may identify patients who have a better prognosis and benefit from additional therapies
@NatasaSpr On the other hand, Reynolds et al pointed out that no sonographic finding has sufficient+consistent sensitivity to be used as a sole criterion to terminate resuscitation ➡️
@NatasaSpr ➡️since it is considered unacceptable to erroneously terminate resuscitation in a patients who could have survived. (Resuscitation 2020;152:56-68)
Nevertheless, according to ERC Guidelines 2021 POCUS should not be used as a sole indicator for terminating CPR.
@NatasaSpr What about the future? Although POCUS is not yet the standard of care for CA patients, it is a valuable tool. Another modality, the Transesophageal echo (TEE) in CA is being investigating the past years, but this is a subject for another ResusciTuesday thread! ❤️💙

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More from @erc_young

Feb 28
This week we will discuss #Ventilation during #Resuscitation. As a starter, we’d like to hear from you.

In your practice, which of the following ventilation parameters do you routinely measure during resuscitation?

@ERC_resus #ResusciTuesdays #ResusTwitter #CPR #ALS
Thanks a lot for all your answers.

Let’s reveal the right answer (and more) through this thread with this interesting information brought by @johannes_wittig
An incomplete story of excessive ventilation during #CPR
 
In 2004, Aufderheide et al. investigated the harmful dimensions of ventilation during CPR. #OHCA CPR attempts of 13 adults were observed; .. (1)..
Read 17 tweets
Feb 23, 2021
Welcome to this weeks #ResusciTuesdays. We will be learning about REBOA in medical cardiac arrest. REBOA stands for ‘Resuscitative Endovascular Balloon Occlusion of the Aorta’. Its aim is to occlude the aorta and therefore improve blood flow to the brain and coronary vessels.
REBOA is sometimes talked about alongside other interventions in cardiac arrest such as ECMO and SAAP (Selective Aortic Arch Perfusion - learn more here: intensivecarenetwork.com/selective-aort…). In this we will just be talking about simple balloon occlusion.
In Trauma, REBOA is used by some services to prevent exsanguinating haemorrhage. There is still a lot of ongoing debate about its use in Trauma, but it has been incorporated into clinical practice in places and there are ongoing trials such as @UKREBOATrial
Read 20 tweets
Feb 22, 2021
Next our very own @ABichmann will be talking about debriefing in resuscitation!
First we hear about how stress and anxiety manifest themselves and about how COVID has heightened many of these feelings! Image
There are many different factors in stress and the impact that it may have. Some stresses are single events. Some may recur and if they recur enough then you may not have time to recover and these may turn into chronic stresses Image
Read 8 tweets
Feb 22, 2021
Our next talk is Patrick Druwe talking about the REAppropriate trial!
To put these results into context we first will talk about the outcomes after OHCA
In Japan there is a high rate of resuscitation attempts in patients who may not have a resuscitation attempt elsewhere! There is therefore a high rate of non-shockable OHCA and these have poorer outcomes!
Read 13 tweets
Feb 22, 2021
The Young ERC webinar has commenced! We will be talking all about Stress and Resuscitation. You can watch along live on our Facebook facebook.com/YoungERC.resus and we will be tweeting about the key takeaway points as we go!
Our first talk is from Kate Vasey who will be talking about the importance of self care!
When we are faced with stress we make an assessment about what we CAN do and what the task will involve. We then make an assessment about whether we can undertake that task and depending on how easily we think we can do it, our body will produce a stress response! Image
Read 11 tweets
Oct 22, 2020
First up @abbamamma discussing the size of the problem with dispatchers/HCPs not being exposed to high loads of cardiac arrest calls and seizure activity a confusing factor #RESUS20
Seizures are hard for lay responders and HCPs to recognise. You can check a pulse as an indication of cardiac arrest but this is hard to teach lay rescuers. Plus arrhythmia may cause a seizure. How do we tackle this?? #RESUS20 #CPR
Can AI help our dispatchers when trying to multi task: taking the call, talking to lay rescuer, dispatching EMS #RESUS20 is protocol with specific training or level of medical training a better system?
Read 13 tweets

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