Is the use of point-of-care ultrasound feasible during cardiac arrest?
Yes. With the caveat that the operator must beware to not increase the time of compressions pause to optimise the views.
Why is point-of-care ultrasound (POCUS) used during a cardiac arrest?
POCUS can be used to search for the possible cause of the cardiac arrest, such as pulmonary embolism, cardiac tamponade and tension pneumothorax. It can also be used as another criterion for cessation of CPR when cardiac standstill is present. It may also show pseudo-PEA (pulseless electrical activity), or PREM (pulseless rhythm with echocardiographic motion).
What is pseudo-PEA or PREM (pulseless rhythm with echocardiographic motion)?
It's the presence of myocardiac activity without a palpable pulse. This may happen due to several causes, and may change the treatment approach in the cardiac arrest, with evidence that standard ACLS should be modified in these cases, with some advocating for the infusion of pressors instead of push-doses, as well as demanding a more careful search for the cause of the arrest.
Point-of-care ultrasound (POCUS) during resuscitation. During pulse check, patient had return of spontaneous circulation, but during ultrasound examination, cardiac rhythm was converted to ventricular fibrillation.
In the beginning of the clip, on parasternal short axis view, contraction of the left ventricle is seen. The probe orientation is then switched to parasternal long axis view (at 0:10). During this evaluation, the left ventricle stopped contracting and "flickered", demonstrating ventricular fibrillation. The ultrasound examination was interrupted and shock was administered, followed by continuation of cardiopulmonary resuscitation.