Point-of-care ultrasound (POCUS) can be extremely helpful during advanced cardiovascular life support (ACLS) with ongoing chest compressions and resuscitation. POCUS can help rule in or out certain etiologies (the H’s and T’s) for why a patient arrested.
During the pulse check, I record the clearest subcostal 4 or 5 chamber view I can obtain. Once CPR is resumed, I review the ultrasound clip for cardiac activity, effusion around the heart, lateralized findings (e.g., a massive RV), etc. As always, the most important rule of ACLS – deliver high quality chest compressions with minimal interruption.
As an intensivist, when I have to pronounce death, I’ll often utilize POCUS to confirm cardiac standstill (as seen in this video). This POCUS clip shows the parasternal long-axis, parasternal short-axis, and subcostal four-chamber views. Notably, one can appreciate complete cardiac standstill with spontaneous echo contrast (a sign of blood stasis) in the ventricular chambers. A finding like this can also be useful during ACLS where peripheral pulses may be difficult to palpate due to body habitus or, even worse, due to cardiac standstill.
Do you routinely see ultrasonography utilized during codes? Drop me a comment below with questions!
