Abstract 1808: FEER: Focussed Echocardiographic Evaluation In Preclinical Resuscitation Management: A Prospective Trial
Purpose In preclinical management of resuscitation BLS and ACLS must be initiated in accordance with the AHA/ERC/ILCOR 2005 guidelines. These guidelines also recommend the identification and treatment of potential reversible causes of cardiac arrest (e.g. cardiac tamponade). Such diagnoses and the response to treatment during CPR cannot be measured by standard care. Furthermore, differential diagnosis of pulseless electrical activity (PEA) is essentially performed by echocardiography (6). Direct visualisation of ventricular wall movement by echocardiography is not routinely available in the out-of-hospital setting. Therefore we developed an algorithm of “Focused Echocardiographic Evaluation in Resuscitation” management (FEER) to obtain an echocardiogram during brief pauses of CPR.
Patients and methods We performed a prospective observational trial to evaluate and feasibility of hand-held ultrasound examinations during resuscitation. Ventricular function was evaluated by means of “eye balling”. Physicians were either experienced in echocardiography or trained.
Results 78 patients were included. Subcostal view was used in 69 of 78 cardiac studies, apical in 36/78 and parasternal in 36/78. Quality of the ultrasound image in the mostly performed subcostal view was considered as being good in 27 of 69 studies, medium in 26/69 or poor 9/69. In 31 of 78 patients PEA was suspected after clinical diagnostic. FEER revealed 11/30 true PEA with no ventricular wall movement. In 20/30 patients correctable causes such as pericardial tamponade (4), poor ventricular function (14) and hypovolemia (2) were identified or treated. In 3 of 4 cases pericardial tamponade was successfully drained. 14/20 patients with correctable causes of cardiac arrest survived to hospital admission while 11 of 11 patients with true PEA died on the scene.
Conclusion In this pilot trial, the application of FEER was feasible, resulted in a considerable information gain and had a therapeutical impact in resuscitation management. FEER enabled to assess differential diagnosis of PEA and resulted in the identification of reversible causes of cardiac arrest when standard care interventions were imprecise.