The utility of cardiac sonography and capnography in predicting outcome in cardiac arrest
© Springer-Verlag London Ltd 2008
Received: 29 January 2008
Accepted: 17 April 2008
Published: 11 September 2008
Emergency physicians and intensivists are increasingly utilizing capnography and bedside echocardiography during medical resuscitations. These techniques have shown promise in predicting outcomes in cardiac arrest, and no cases of return of spontaneous circulation in the setting of sonographic cardiac standstill and low end-tidal carbon dioxide have been reported. This case report illustrates an example of such an occurrence. Our aims are to report a case of return of spontaneous circulation in a patient with sonographic cardiac standstill, electrocardiographic pulseless electrical activity, and low end-tidal carbon dioxide tensions and to place the case in the context of previous literature on this topic. Case report and brief review of the literature. In 254 cases reported, no patient has survived in the setting of sonographic cardiac standstill and low end-tidal carbon dioxide tension, making the reported case unique. This case should serve to illustrate the utility and limitations of combined cardiac sonography and end-tidal carbon dioxide measurement in determining prognosis during cardiac arrest.
Given the low survival rate for cardiac arrest both in the field and in hospital, it would be useful to have rapid, noninvasive means to guide treatment and predict outcome. Early studies of end-tidal carbon dioxide tension (ETCO2) monitoring and bedside cardiac sonography have shown great promise in predicting survival from cardiac arrest. Use of this technology is becoming more widespread; a recent review outlined a method for the incorporation of bedside sonography into standard advanced cardiac life support (ACLS) protocols . To date, no study has reported survival in a patient with cardiac standstill and a low ETCO2 and these criteria are often used to aid in the decision to terminate resuscitation. We report a case of return of spontaneous circulation (ROSC) despite a very low ETCO2 and sonographic asystole.
Summary of survival from cardiac arrest in patients without cardiac activity (CA) on bedside sonography
This patient may represent a false negative (+ROSC in the setting of negative echo and ETCO2) which was not demonstrated in earlier studies due to a lack of power. Alternatively, the patient’s youth and lack of past medical history, coupled with a witnessed arrest, may have granted a better prognosis than the patients enrolled in prior studies, who tended to be older, have comorbidities, and whose codes often began in the field. As greater numbers of patients are enrolled in studies utilizing ETCO2 and bedside echo as prognostic indicators, we should develop a better sense of their true accuracy in prognosis as well as their value in guiding resuscitative efforts in the ED and ICU settings.
Conflicts of interest
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