Student ID number
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CPR: Cardiopulmonary Resuscitation
POCUS-CA: Point of care ultrasound in cardiac arrest
CASA: Cardiac Arrest Sonographic Assessment
ROSC: Return to spontaneous circulation
Critical care facilities throughout the world have found the use of ultrasound focused on a specific health issue to be beneficial. Ultrasound machines may be found in nearly every emergency room and critical care unit, making it easy for doctors to examine patients’ health and treat them as quickly as possible (Tabibzadeh Dezfuli et al., 2019). With the use of focused ultrasound, the different causes of instability may be swiftly identified, and treatment options can be devised fast and effectively. Several studies have shown that non-radiologists may effectively make focused images, analyze the accompanying data, and incorporate the knowledge into their diagnostic armament.
‘Ultrasound in the diagnosis and management of shock and cardiac arrest’
It is vital for medical specialists to detect, and treat the critically ill shock patients since this state has a high death rate. According to Tabibzadeh Dezfuli et al. (2019), a physical examination by medical specialists is unable to accurately identify the source of shock in patients. The use of invasive procedures, such as right cardiac catheterization, provides real-time information to aid in diagnosis; nevertheless, it necessitates the employment of specially trained individuals and is connected to iatrogenic complications that do not enhance patient results. An important noninvasive tool in the emergency room and intensive care unit is ultrasonography, which may be used to distinguish between different causes of shock and to assess their severity (Blaj et al., 2019). Ultrasonography is used in a variety of domains, allowing doctors to make more confident and definite choices. A protocolized ultrasound strategy may have a significant impact on the duration of stay, morbidity, and mortality of the shock patients, according to the research carried out by Schnittke et al. (2021).
Early use of ultrasound in the assessment and treatment of shock patients has been shown to have a positive impact on renal outcomes, which are known to have a significant impact on morbidity and mortality (Stickles et al., 2019). A higher mortality risk has been linked to even small increases in blood creatinine levels, and this risk only grows as renal impairment worsens. There is a four-fold increase in mortality, a four-fold increase in length of stay, and a four-fold increase in costs associated with acute renal injury (Stickles et al., 2019). An advantage of using ultrasonography, as identified in the research, is that it can detect the underlying cause of shock earlier on, allowing for a more precise fluid strategy to be implemented in order to restore renal perfusion. Mortality and morbidity rates fell short of statistical significance in other variables.
Unexpected cardiac arrest is described as a cardiac arrest that comes suddenly and may lead to attempts to restore circulation in the case of cardiac arrest, which is verified by the lack of blood circulation. Treatment-related medications that are provided on-site might health to support the health of a patient (Balderston et al., 2021). An ultrasonography in cardiac arrest carried out by a skilled medical specialist may evaluate compression quality, quickly find adjustable effects of arrest with non-defibrillable schemes, monitor therapies, and eventually evaluate the results obtained from therapy. In addition, ultrasonography in cardiac arrest gives prognostic data concerning the prospect of a reoccurrence to spontaneous circulation and survival. Due to greater accessibility, ultrasound has become a more convenient and portable tool for physicians in the field. For critically ill patients, ultrasound has improved to the point where it is a harmless and precise diagnostic means (Berg, 2018).
CPR protocols have progressed in the past era in terms of the use of advanced measurements, early involvement in defibrillating rhythms, and the effect of the electrical level of the arrest (Fitzgibbon et al., 2019). They are now more effective. Despite this, the poor survival rate, which is influenced by many factors, means that it continues to provide unproductive results. Medical professionals have a lot of challenges when it comes to mechanical breathing during a patient’s cardiac arrest since it has physiological effects on the patient. As the procedure of ultrasound as an analytic and prognostic tool becomes more prevalent, it is vital that high-quality research, such as randomized clinical trials, be conducted to establish the validity of ultrasound as a point-of-care diagnostic tool in cardiac arrest (Gottlieb & Alerhand, 2020). Furthermore, medical experts must intervene in ultrasound training so that it can be done more quickly and effectively in stressful conditions; checklists can be used to enable rapid picture capture and interruption control.
Evidence that ultrasound improves outcomes in cardiac arrest
To minimize future difficulties, medical personnel dealing with cardiac or respiratory arrest must follow a strict protocol that includes ultrasonography as part of their treatment plan. Once these first steps are completed, the engraving process may begin, depending on the capabilities of the ultrasound scanner, which can have a deferment in beginning the recording purpose and a limited amount of memory for the process, so it’s important to take these factors into account. Both inpatient and outpatient studies have looked at the use of ultrasonography in cardiac arrest. Many methods exist for doing the POCUS-CA, and no study has been able to identify which one is the most effective (Kedan et al., 2020). But it is apparent that the more gaps that are reviewed, the more chance of achievement in gathering results for the integration of information and the production of an effective clinical interpretation, which is crucial for decision-making that might change the prognosis of the patient. These techniques need instruction, and research suggests that the use of ultrasonography in this setting may result in longer CPR interruptions and a longer restart time, both of which might lead to worse results. One of the most recent studies carried out by Gardner (2018) on the CASA procedure had 276 patients who were followed prospectively (Gardner KF et al., 2018). Intermittently testing for cardiac tamponade, RV trauma, and cardiac action with yes-or-no answers is the goal of the CASA procedure. A reduction in interruption time of 19.8 and 15.8 seconds was seen in the findings when the procedure was conducted by occupants of the university.
Atkinson (2019) and other researchers from the SHoC-ED group reported in 2019 that a reflective cohort analysis of one hundred and eighty emergency department patients who underwent POCUS-CA indicated that those with positive results or when POCUS-CA was not conducted got longer resuscitation and higher intervention rates (Atkinson P et al., 2019). Cardioactive patients who received POCUS-CA had better clinical results than those who did not get POCUS-CA or those who did not have cardiac activity identified by the device. In a meta-analysis published in Resuscitation, a total of 1695 patients from 15 studies resolved that POCUS-CA might be relied on purposely to identify adjustable bases and foretell short-term consequences in patients suffering from cardiac arrest (Atkinson P et al., 2019). When a patient has a history of poor ROSC rates, the lack of spontaneous cardiac activities on echocardiography might indicate a high probability of death and impact the choice to stop recovery in the particular patients.
For nontraumatic cardiac arrest and non-defibrillable rhythms, POCUS-CA was related to a larger likelihood of ROSC, as well as better outcomes after discharge, based on a methodical review and metanalysis of ten studies (Tsou P-Y et al., 2017). Following these findings, it may be concluded that transthoracic echocardiography can be used to accurately predict short-term cardiac resuscitation outcomes by measuring heart motion. As long as ultrasound does not cause the patient to lose consciousness, POCUS-CA can be used during cardiopulmonary resuscitation in the emergency department because of the technology’s safety and ease of use.
Alternatively, in other cases, such as those involving patients in the emergency room, there are only a few data available concerning physiological reasons that caused a patient’s cardiac arrest and the possibility that the intensivist called in to aid would survive (Lalande E et al., 2019). In addition, bedside ultrasonography as an essential tool for giving relevant information to assist lead care has confirmed promising outcomes. It’s important to remember that the results of ultrasound should never be used to make a judgment about whether or not to continue resuscitation (Jaramillo et al., 2020). The POCUS in cardiac arrest is a brilliant addition to other therapies when applied by competent medical specialists.
In conclusion, early use of ultrasound in individuals with shock has been proven to improve kidney outcomes. Renal outcomes strongly influence morbidity and mortality. To assess if the implementation of an early protocolized ultrasound examination for shock patients has an impact on other clinical outcomes, additional study is needed. Patients in critical condition may now be diagnosed using ultrasound in a wide range of settings, including hospitals. Ultrasonography should be included in resuscitation algorithms, however further study is needed to prove its effectiveness (Chou et al., 2020). During cardiac resuscitation, it is proved that only through teamwork and the use of ultrasonography as part of a multidisciplinary approach might a positive clinical result be obtained. Ultrasound permits actual monitoring of all the patients’ reaction to treatment, as well as guiding during diagnostic procedures.
Atkinson P, Beckett N, French J et al. (2019) Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. Cureus. 11(4):e4456
Balderston, J. R., You, A. X., Evans, D. P., Taylor, L. A., & Gertz, Z. M. (2021). Feasibility of focused cardiac ultrasound during cardiac arrest in the emergency department. Cardiovascular Ultrasound, 19(1), 1-5.
Berg, K. (2018). Finding a window: Timing of cardiac ultrasound acquisition during cardiac arrest. Resuscitation, 124, A11.
Blaj, G., Liang, M., Aquila, A. L., Willmott, P. R., Koglin, J. E., Sierra, R. G., … & Stan, C. A. (2019). Generation of high-intensity ultrasound through shock propagation in liquid jets. Physical Review Fluids, 4(4), 043401.
Chou, E. H., Wang, C. H., Monfort, R., Likourezos, A., Wolfshohl, J., Lu, T. C., … & Lin, J. (2020). Association of ultrasound-related interruption during cardiopulmonary resuscitation with adult cardiac arrest outcomes: A video-reviewed retrospective study. Resuscitation, 149, 74-80.
Fitzgibbon, J. B., Lovallo, E., Escajeda, J., Radomski, M. A., & Martin-Gill, C. (2019). Feasibility of out-of-hospital cardiac arrest ultrasound by EMS physicians. Prehospital Emergency Care, 23(3), 297-303.
Gardner KF, Clattenburg EJ, Wroe P et al. (2018) The Cardiac Arrest Sonographic Assessment (CASA) exam – A standardized approach to using ultrasound in PEA. Am J Emerg Med 36(4):729–731
Gottlieb, M., & Alerhand, S. (2020). Ultrasonography: a useful adjunct in cardiac arrest. Annals of emergency medicine, 75(4), 514-515.
Jaramillo, G. D., Aldana, N. N., & Ortiz, Z. R. (2020). Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia. International Journal of Emergency Medicine, 13(1), 1-5.
Kedan I, Ciozda W, Palatinus J et al. (2020) Prognostic value of point-of-care ultrasound during cardiac arrest: a systematic review. Cardiovasc Ultrasound 18:1
Lalande E, Burwash-Bernnan T, Buns K et al. (2019) Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHoC investigators. Resuscitation. 139:159–166
Schnittke, N., Schmidt, J., Resop, D., Neasi, E., & Damewood, S. (2021). 379 Reliability of Cardiopulmonary Ultrasound Interpretation During Resuscitation of Patients With Suspected Septic Shock. Annals of Emergency Medicine, 78(4), S152.
Stickles, S. P., Carpenter, C. R., Gekle, R., Kraus, C. K., Scoville, C., Theodoro, D., … & Raio, C. (2019). The diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology: a systematic review and meta-analysis. Canadian Journal of Emergency Medicine, 21(3), 406-417.
Tabibzadeh Dezfuli, S. A., Ghasemi, H., & Yazdani, R. (2019). Investigation of Accuracy of Rapid Ultrasound in Shock (RUSH) on Detection of Early Rapid Shock Type in Emergency Patients. GMJ Medicine, 3(1), 149-155.
Tsou P-Y, Kurbedin J, Chen Y-S (2017) Accuracy of point-of-care focused echocardiography in predicting the outcome of resuscitation in cardiac arrest patients: a systematic review and meta-analysis. Resuscitation 114:92–99