AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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While you cannot see the hand on the heart, this is an echo of internal cardiac massage. The patient has a PFO causing a left to right shunt that is small. The heart is asystolic.
Echo in Life Support (ELS) has been studied to determine if echo exams during cardiac arrest would be feasible and helpful in the outcome of a patient. ELS can indicate volume status of the heart, tamponade and/or pericardial effusions, pleural effusions, shunts, regurgitation, dissection, pulmonary embolism (2D or 3D) and wall motion abnormalities that could impact the outcome of the patient who requires cardiac life support. One study showed that 12% of patients had an intervention from the echo results. Wall motion of the ventricle had a positive predictive value of 55%. Absence of ventricular wall motion had a negative predictive value of 97%. In another study ELS altered therapy in 78% of patients. In both studies, 94% of patients had an adequate echo study for diagnosis and assessment.
A single day training course did not compromise the outcomes of cardiac arrest patients and novice providers were able to obtain views in a short period of time (10 seconds) during a cardiac arrest. The echo exam was built into the ALS protocol in this situation.
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An evaluation of echo in life support (ELS): is it feasible? What does it add?
Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial.
Emergent bedside real-time three-dimensional transesophageal echocardiography in a patient with cardiac arrest following a caesarean section.
Peri-resuscitation echocardiography: training the novice practitioner.
Echocardiography in cardiac arrest.