Abstract
Background
We previously developed a US-CAB protocol for evaluation of circulatory-airway-breathing
status during cardiopulmonary resuscitation (CPR). This study aimed at validating
its application in real CPR scenarios and the potential impact on CPR outcomes.
Methods
The US-CAB protocol was implemented at the emergency department of National Taiwan
University Hospital since January 2016. The US images, initiation time and operation
duration of each US-CAB procedure, and relevant CPR information were recorded for
analysis.
Results
From January 2016 to March 2017, 177 cardiac arrest patients receiving US-CAB were
included. The durations of US-C-A-B procedure were 9.0 ± 1.4, 7.5 ± 1.5, and 16.0 ± 1.9 s,
respectively. Cardiac activity was identified in 47 cases (26.6%), with higher rates
of return of spontaneous circulation (ROSC) (95.7% vs. 21.5%, p < .0001) and survival to hospital discharge (25.5% vs. 10.0%, p < .01). Detection of cardiac activity after 10 min of CPR exhibited 100%
sensitivity, specificity, positive and negative predictive value for ROSC. Cardiac
tamponade was noted in eight patients. ROSC was achieved in two (25.0%) after pericardiocentesis,
and aortic dissection was diagnosed in one (12.5%). Confirmation of correct intubation
was significantly faster by US than by capnography (7.4 ± 1.4 vs. 38.3 ± 110.2 s, p < .001). US detected 21 (11.9%) esophageal intubations and 3 (1.7%)
one-lung intubations. All were promptly corrected.
Conclusion
The US-CAB protocol is feasible in real CPR scenarios. It confers diagnostic value
and prognostic implications which potentially impact the efficacy and outcomes of
CPR. However, a future prospective multi-center study to validate its feasibility
and indicate the need of structured training is mandated.
Keywords
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References
- Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial.Resuscitation. 2010; 81: 1527-1533
- Bedside ultrasound reduces diagnostic uncertainty and guides resuscitation in patients with undifferentiated hypotension.Crit Care Med. 2015; 43: 2562-2569
- BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.Chest. 2015; 147: 1659-1670
- Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.Resuscitation. 2016; 109: 33-39
- Echocardiography for prognostication during the resuscitation of intensive care unit patients with non-shockable rhythm cardiac arrest.Resuscitation. 2015; 92: 1-6
- Cardiac arrest ultra-sound exam-a better approach to managing patients in primary non-arrhythmogenic cardiac arrest.Resuscitation. 2008; 76: 198-206
- The RUSH exam: rapid ultrasound in shock in the evaluation of the critically.Emerg Med Clin North Am. 2010; 28: 29-56
- Critical care ultrasound in cardiac arrest. Technological requirements for performing the SESAME-protocol-a holistic approach.Anaesthesiol Intensive Ther. 2015; 47: 471-481
- Part 1: executive summary: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2010; 122: S640-656
- Feasibility of correlating the pulse check with focused point-of-care echocardiography during pediatric cardiac arrest: a case series.Resuscitation. 2008; 77: 264-269
- Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial.BMJ. 2010; 341: c5943
- Tracheal rapid ultrasound exam (T.R.U.E:) for confirming endotracheal tube placement during emergency intubation.Resuscitation. 2011; 82: 1279-1284
- Ultrasonographic lung sliding sign in confirming proper endotracheal intubation during emergency intubation.Resuscitation. 2012; 83: 307-312
- Tracheal ultrasonography and ultrasonographic lung sliding for confirming endotracheal tube placement: speed and reliability.Am J Emerg Med. 2016; 34: 953-956
- A novel US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation.Resuscitation. 2017; 115: e1-e2
- Data on evaluation of proficiency for the US-CAB curriculum. Data in Brief.2017 (submitted for publication)
- Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department.Intensive Care Med. 2013; 39: 1290-1298
- Approximate is better than exact for interval estimation of binomial proportions.Am Stat. 1998; 52: 119-126
- Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review.Acad Emerg Med. 2012; 19: 1119-1126
- Introduction of paramedic led echo in life support into the pre-hospital environment: the PUCA study.Resuscitation. 2017; 112: 65-69
- Comparison of three different methods to confirm tracheal tube placement in emergency intubation.Intensive Care Med. 2002; 28: 701-704
- The assessment of three methods to verify tracheal tube placement in the emergency setting.Resuscitation. 2003; 56: 153-157
- Endotracheal tube placement confirmation: 100% sensitivity and specificity with sustained four-phase capnographic waveforms in a cadaveric experimental model.Resuscitation. 2017; 115: 192-198
- Factors complicating interpretation of capnography during advanced life support in cardiac arrest-a clinical retrospective study in 575 patients.Resuscitation. 2012; 83: 813-818
- Ultrasound instead of capnometry for confirming tracheal tube placement in an emergency.Resuscitation. 2011; 82: 1259-1261
- Cardiac arrest due to food asphyxiation in adults: resuscitation profiles and outcomes.Resuscitation. 2010; 81: 1082-1086
- Computed tomography findings of complications resulting from cardiopulmonary resuscitation.Resuscitation. 2015; 88: 86-91
- Appropriate documentation of confirmation of endotracheal tube position and relationship to patient outcome from in-hospital cardiac arrest.Resuscitation. 2013; 84: 31-36
- Verification of endotracheal intubation in obese patients – temporal comparison of ultrasound vs. auscultation and capnography.Acta Anaesthesiol Scand. 2012; 56: 571-576
- Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital.Am J Emerg Med. 2012; 30: e2085-e2086
- Insertion of the endotracheal tube, laryngeal mask airway and oesophageal-tracheal Combitube. A 6-month comparative prospective study of acquisition and retention skills by medical students.Eur J Anaesthesiol. 2005; 22: 337-340
- Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions.Resuscitation. 2017; 119: 95-98
- Hands-off time during insertion of six airway devices during cardiopulmonary resuscitation: a randomised manikin trial.Resuscitation. 2011; 82: 1060-1063
- Shock advisory system with minimal delay triggering after end of chest compressions: accuracy and gained hands-off time.Resuscitation. 2011; 82: S8-S15
- European Resuscitation Council guidelines for resuscitation 2015: section 1. Executive summary.Resuscitation. 2015; 95: 1-80
- Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation.Resuscitation. 2013; 84: 1708-1712
- Predicting the outcomes for out-of-hospital cardiac arrest patients using multiple biomarkers and suspension microarray assays.Sci Rep. 2016; 6: 27187
- European Resuscitation Council guidelines for resuscitation 2015: section 3: adult advanced life support.Resuscitation. 2015; 95: 100-147
Article info
Publication history
Published online: February 01, 2018
Accepted:
January 30,
2018
Received in revised form:
January 25,
2018
Received:
September 10,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.01.051.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
