Dr. Michael Allison is a Chief Resident in the combined Emergency Medicine/Internal Medicine/Critical Care Residency. He was invited to the recent Greater Chesapeake Emergency Medicine Conference to speak about ways to improve upon cardiac arrest care – using principles as applicable in the ICU as in they are in the Emergency Department. In under twenty minutes he’ll teach you a few things on how to appropriately monitor your arrest patient using ultrasound and end-tidal CO2. Using these tips may make your next resuscitation a success!
Pearls
- Cardiac ultrasound is really only helpful early in PEA arrest. Don’t even bring it in the room if there’s a shockable rhythm!
- The Stoplight Approach to ending resuscitation: No activity? Stop. Some activity? Consider your clinical scenario. Organized contractions? Keep going.
- Use end-tidal CO2 to monior your compressions. Decreasing ETCO2 over time may signal early compressor fatigue!
- Jumps of greater than 10mmHg in ETCO2 can be an early indicator of ROSC! Just make sure it’s not from the bicarbonate, which can artificially increase the ETCO2.
Suggested Reading
1. Robson R. Echocardiography during CPR: More studies needed. Resuscitation 2010;81:1453-1454.
2. Blyth L, Atkinson P, Gadd K, et al. Bedside Focused Echocardiography as Predictor of Survival in Cardiac Arrest Patients: A Systematic Review. Acad Emerg Med 2012;19:1119-1125.
3. Touma O, Davies M. The prognostic value of end tidal carbon dioxide during cardiac arrest: A systematic review. Resuscitation 2013 July; [epub ahead of print].
4. Pokorna M, Necas E, Kratochvil J et al. A sudden increase in partial pressure end-tidal carbon dioxide (PETCO2) at the moment of return of spontaneous circulation. J Emerg Med 2010;38:614-621.
1. Robson R. Echocardiography during CPR: More studies needed. Resuscitation 2010;81:1453-1454.
2. Blyth L, Atkinson P, Gadd K, et al. Bedside Focused Echocardiography as Predictor of Survival in Cardiac Arrest Patients: A Systematic Review. Acad Emerg Med 2012;19:1119-1125.
3. Touma O, Davies M. The prognostic value of end tidal carbon dioxide during cardiac arrest: A systematic review. Resuscitation 2013 July; [epub ahead of print].
4. Pokorna M, Necas E, Kratochvil J et al. A sudden increase in partial pressure end-tidal carbon dioxide (PETCO2) at the moment of return of spontaneous circulation. J Emerg Med 2010;38:614-621.
