Dr. Gardner, Dr. Clattenburg, and Dr. Wroe are emergency medicine residents at Highland Hospital, Alameda Health System, in Oakland, California.
Dr. Nagdev is director of emergency ultrasound at Highland Hospital.
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Topics: Cardiac ArrestDiagnosisEmergency MedicineEmergency PhysicianImaging and UltrasoundPOCUS
ACEP Now: Vol 38 – No 08 – August 2019
May 6, 2018
Respectfully, no way that “pericardial effusion causing cardiac tamponade is…the cause of cardiac arrest in 4 to 15 percent of patients”.
The high-end 15% figure appears to come from reference #6, an 2003 observational study of 20 cardiac arrest patients at a single hospital over an 18 month period. Perhaps not what you should hang your hat on statistically.
Also, while certainly the article is focused on patients in PEA, you should be careful about making that clear when quoting statistics — the sentence about the rate of tamponade-induced cardiac arrest does not indicate you are limiting yourself to patients in PEA, although the underlying study is so limited.
I ultrasound every cardiac arrest I see. Even in patients with PEA, my clinical experience is that nowhere near 15% of them have tamponade or even an effusion.
May 13, 2018
Completely agree with your comment. The rates are much lower than the 15%, but this is really all we have in the way of literature. In our just published 2018 Resuscitation paper “Clattenburg, et al.”, we did not have those numbers as well for pericardial effusions.
The goal of the CASA protocol is to allow the clinician to simplify the ultrasound aspect when running an OHCA, and ensure high quality CPR. By making the clinician look quickly for the presence or absence of a pericardial effusion, it allows him/her to move to other items that are on the differential.
Thanks for your great comment.
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