I have been a firm believer in ECHO during cardiac arrest for many years. I often stray from the guidelines and will shock patients in ECG asystole, as the evidence is there, that some of these patients are in Ventricular Fibrillation (VF) which is not shown on ECG. The reality is that we don’t know how sensitive the ECG is as we assume it to be the gold standard.
We diagnose VF by looking at the ECG trace on a monitor, or the ECG tracing itself. The accuracy of this method in detecting VF is unknown. The use of point of care echocardiography, can allow us to visualise the heart fibrillating and make the correct diagnosis, even of the ECG trace is showing a different rhythm.
This study aimed to identify the prevalence and survival impact of occult VF in out of hospital cardiac arrest (OHCA).
Briefly
This was a multicenter, prospective observational trial in 28 emergency departments in the United States and Canada, of adult patients with non-traumatic cardiac arrest.
Primary Outcome: Prevalence of VF on echo, not identifed by ECG.
Secondary Outcomes:
- Survival to hospital discharge,
- Defbrillation resulting in termination of VF, ROSC (defined as detection of a palpable pulse or a measurable blood pressure for greater than a minute)
What They Found
43/811(5.3%) of patients with OHCA had occult VF during the first 3 pauses in CPR. They displayed the following non-shockable rhythms on ECG………..
This review was first published at www.emmastery.org by Dr Peter Kas
