Point-of-care ultrasound (POCUS) is a powerful diagnostic tool in the emergency department. To identify reversible causes of pulseless electrical activity (PEA), emergency physicians have started integrating POCUS into the evaluation of patients in cardiac arrest, leading to its current recommendation from the American Heart Association (AHA).1
However, two recent studies have demonstrated that ED POCUS use in the resuscitation of out-of-hospital cardiac arrests (OHCAs) may prolong CPR pauses, which has been shown to negatively impact survival.2,3 In our experience, even experienced ED sonographers can have difficulty simultaneously obtaining adequate echocardiographic views and interpreting their images in the 10-second CPR pause interval, leading to unintended prolonged CPR pauses.
Protocol = Solution
A potential solution for minimizing CPR interruptions may be to protocolize POCUS integration in the resuscitation of the OHCA patient. Prior protocols have been suggested, but they are too complex and can reduce the possibility of clinical implementation. A simplified protocol most ED sonographers can easily perform may reduce the cognitive load of running a complex resuscitation, facilitate detection of reversible causes of OHCA, and prevent prolonged CPR pauses.