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LO045: Sonography in Hypotension and Cardiac Arrest (SHoC) - Cardiac Arrest: A consensus on the integration of point of care ultrasound into advanced cardiac life support during cardiac arrest

Published online by Cambridge University Press:  02 June 2016

P. Atkinson
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC Dalhousie University, Saint John Regional Hospital, New Brunswick, Toronto, ON
J. Bowra
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC Australasian College for Emergency Physicians, West Melbourne, VC
J. Milne
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
M. Lambert
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
B. Jarman
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
V. Noble
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC American College of Emergency Medicine, Dallas, TX
H. Lamprecht
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
D. Lewis
Affiliation:
Dalhousie University, Saint John Regional Hospital, New Brunswick, Toronto, ON Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
T. Harris
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
R. Gangahar
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
S. Bomann
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
A. Goudie
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
H. Poncia
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
A. Bystrzycki
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
G. Blecher
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
M. Rose
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
S. Dass
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
O. Doran
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
R. Large
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
A. Salter
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
J. Sadewasser
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
A. Murray
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
M. Rawson
Affiliation:
Australasian College for Emergency Physicians, West Melbourne, VC
M. Stander
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
C. Muhr
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
J. Connolly
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
R. Gaspari
Affiliation:
American College of Emergency Medicine, Dallas, TX
R. Kessler
Affiliation:
American College of Emergency Medicine, Dallas, TX
C. Raio
Affiliation:
American College of Emergency Medicine, Dallas, TX
P. Sierzenski
Affiliation:
American College of Emergency Medicine, Dallas, TX
B. Hoffmann
Affiliation:
American College of Emergency Medicine, Dallas, TX
C. Pham
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
M. Woo
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
P. Olszynski
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
R. Henneberry
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
O. Frenkel
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
J. Chenkin
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
G. Hall
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
L. Rang
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
M. Valois
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
C. Wurster
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
M. Tutschka
Affiliation:
Critical Care/Pediatric Point of Care Ultrasound, Saint John Regional Hospital, New Brunswick, Toronto, ON
R. Arntfield
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
J. Fischer
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON Critical Care/Pediatric Point of Care Ultrasound, Saint John Regional Hospital, New Brunswick, Toronto, ON
M. Tessaro
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON Critical Care/Pediatric Point of Care Ultrasound, Saint John Regional Hospital, New Brunswick, Toronto, ON

Abstract

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Introduction: Point of care ultrasound (PoCUS) provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm. We consider that a consensus-based priority checklist using a “4 F’s” approach (Fluid; Form; Function; Filling), would provide a better algorithm during ACLS. Methods: The ultrasound subcommittee of the Australasian College for Emergency Medicine (ACEM) drafted a checklist incorporating PoCUS into the ACLS algorithm. This was further developed using the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. A modified Delphi tool was developed to reach an international consensus on how to integrate ultrasound into cardiac arrest algorithms for emergency department patients. Results: Consensus was reached following 3 rounds. The agreed protocol focuses on the timing of PoCUS as well as the specific clinical questions. Core cardiac windows performed during the rhythm check pause in chest compressions are the sub-xiphoid and parasternal cardiac views. Either view should be used to detect pericardial fluid, as well as examining ventricular form (e.g. right heart strain) and function, (e.g. asystole versus organized cardiac activity). Supplementary views include lung views (for absent lung sliding in pneumothorax and for pleural fluid), and IVC views for filling. Additional ultrasound applications are for endotracheal tube confirmation, proximal leg veins for DVT, or for sources of blood loss (AAA, peritoneal/pelvic fluid). Conclusion: The authors hope that this process will lead to a consensus-based SHoC-cardiac arrest guideline on incorporating PoCUS into the ACLS algorithm.

Type
Oral Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2016