Cardiac movement identified on prehospital echocardiography predicts outcome in cardiac arrest patients.

INTRODUCTION: The prognostic value of emergency echocardiography (EE) in the management of cardiac arrest patients has previously been studied in an in-hospital setting. These studies mainly included patients who underwent cardiopulmonary resuscitation (CPR) by emergency medicine technicians at the scene and who arrived at the emergency department (ED) still in a state of cardiac arrest. In most European countries, cardiac arrest patients are normally treated by physician-staffed emergency medical services (EMS) teams on scene. Transportation to the ED while undergoing CPR is uncommon. OBJECTIVE: To evaluate the ability of EE to predict outcome in cardiac arrest patients when it is performed by ultrasound-inexperienced emergency physicians on scene. METHODS: We performed a prospective, observational study of nonconsecutive, nontrauma, adult cardiac arrest patients who were treated by physician-staffed urban EMS teams on scene. Participating emergency physicians (EPs) received a two-hour course in EE during CPR. After initial procedures were accomplished, EE was performed during a rhythm and pulse check. A single subxiphoid, four-chamber view was required for study enrollment. We defined sonographic evidence of cardiac kinetic activity as any detected motion of the myocardium, ranging from visible ventricular fibrillation to coordinated ventricular contractions. The CPR had to be continued for at least 15 minutes after the initial echocardiography. No clinical decisions were made based on the results of EE. RESULTS: Forty-two patients were enrolled in the study. The heart could be visualized successfully in all patients. Five (11.9%) patients survived to hospital admission. Of the 32 patients who had cardiac standstill on initial EE, only one (3.1%) survived to hospital admission, whereas four out of 10 (40%) patients with cardiac movement on initial EE survived to hospital admission (p = 0.008). Neither asystole on initial electrocardiogram nor peak capnography value, age, bystander CPR, or downtime was a significant predictor of survival. Only cardiac movement was associated with survival, and cardiac standstill at any time during CPR resulted in a positive predictive value of 97.1% for death at the scene. CONCLUSION: Our results support the idea of focused echocardiography as an additional criterion in the evaluation of outcome in CPR patients and demonstrate its feasibility in the prehospital setting.

Contrast-enhanced ultrasound detects gallbladder perforation in a patient with acute abdominal pain.

We present the case of a patient with abdominal pain, in which gallbladder perforation was detected by contrast-enhanced ultrasound. A 90-year-old patient presented to the emergency department with a complaint of acute abdominal pain and vomiting. An abdominal ultrasound revealed a thickened gallbladder wall and small amounts of perihepatic fluid. Because these findings were suspicious for gallbladder perforation and contrast-enhanced computed tomography could not be performed because of a history of monoclonal gammopathy, a contrast-enhanced ultrasound scan was performed. After the administration of 2.5 mL of SonoVue (Bracco, Milan, Italy), a defect of the gallbladder wall was detected. The patient underwent laparotomy, on which the diagnosis of gallbladder perforation was confirmed.

Prehospital lung ultrasound in the distinction between pulmonary edema and exacerbation of chronic obstructive pulmonary disease.

We present 2 cases of dyspneic patients, where prehospital lung ultrasound helped to distinguish between pulmonary edema and acute exacerbation of chronic obstructive pulmonary disease.