European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances.

The Canadian Association of Emergency Physicians (CAEP) recognizes the role of point-of-care ultrasound (POCUS) as a valuable adjunct to the delivery of excellent emergency care. With this document, the CAEP Emergency Ultrasound Committee (EUC) updates the previous CAEP POCUS position statement and provides an expanded framework and series of recommendations, based on the current evidence, to guide emergency departments (ED) and their POCUS programs in the delivery of high quality patient care. Evaluating and summarizing the evidence for the use of POCUS is challenging because, unlike other diagnostic tests where research is primarily focused on test performance, the value of POCUS is further scrutinized in terms of patient-oriented outcomes and system performance measures, such as time to diagnosis or length of stay. Add to this the operator-dependent nature of POCUS, and, not surprisingly, the application of POCUS literature becomes understandably complex. The recommendations reflect the authors’ synthesis of a combination of test performance metrics, patientoriented outcomes, and system performance measures (when available). To date, there is still a paucity of prospective POCUS research focused on patient-oriented outcomes, but the authors do believe there is sufficient evidence in the current literature to support the recommendations within this document.

Recommendations for the use of point-of-care ultrasound (POCUS) by emergency physicians in Canada

Implementation of the Cardiac Arrest Sonographic Assessment (CASA) protocol for patients with cardiac arrest is associated with shorter CPR pulse checks.

Transoesophageal echocardiography in cardiac arrest: A systematic review.

Patients with cardiac arrest present as a relatively frequent occurrence in the Emergency Department. Despite the advances in our understanding of the pathophysiology of cardiac arrest, managing the condition remains a stressful endeavor and currently implemented interventions, while beneficial, are still associated with a disappointingly low survivability. The majority of modern Advanced Life Support algorithms employ a standardized approach to best resuscitate the ‘crashed’ patient. However, management during resuscitation often encourages a ‘one-size-fits-all’ policy for most patients, with lesser attention drawn towards causality of the disease and factors that could alter resuscitative care. Life support providers are also often challenged by the limited bedside predictors of survival to guide the course and duration of resuscitation. Over the recent decades, point-of-care ultrasonography (PoCUS) has been gradually proving itself as a useful adjunct that could potentially bridge the gap in the recognition and evaluation of precipitants and end-points in resuscitation, thereby facilitating an improved approach to resuscitation of the arrested patient. Point-of-care ultrasound applications in the critical care field have tremendously evolved over the past four decades. Today, bedside ultrasound is a fundamental tool that is quick, safe, inexpensive and reproducible. Not only can it provide the physician with critical information on reversible causes of arrest, but it can also be used to predict survival. Of note is its utility in predicting worse survival outcomes in patients with cardiac standstill, i.e., no cardiac activity witnessed with ultrasound. Unfortunately, despite the increasing evidence surrounding ultrasound use in arrest, bedside ultrasound is still largely underutilized during the resuscitation process. This article reviews the current literature on cardiac standstill and the application of bedside ultrasound in cardiac arrests.

/pdf/bedside-ultrasound-in-cardiac-standstill-a-clinical-review-3vl0zxb983.pdf

Bedside ultrasound in cardiac standstill: a clinical review

Transesophageal Echocardiography: Guidelines for Point-of-Care Applications in Cardiac Arrest Resuscitation

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Transesophageal Echocardiography: Guidelines for Point-of-Care Applications in Cardiac Arrest Resuscitation