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Gaspari R, Harvey J, DiCroce C, et al. Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS - A prospective Cohort Study. Resusc Plus. 2021;6:100094doi: 10.1016/j.resplu.2021.100094.
Gaspari, R., Harvey, J., DiCroce, C., Nalbandian, A., Hill, M., Lindsay, R., Nordberg, A., Graham, P., Kamilaris, A., & Gleeson, T. (2021). Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS - A prospective Cohort Study. Resuscitation plus, 6100094. https://doi.org/10.1016/j.resplu.2021.100094
Gaspari, Romolo, et al. "Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS - A prospective Cohort Study." Resuscitation plus vol. 6 (2021): 100094. doi: https://doi.org/10.1016/j.resplu.2021.100094
Gaspari R, Harvey J, DiCroce C, Nalbandian A, Hill M, Lindsay R, Nordberg A, Graham P, Kamilaris A, Gleeson T. Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS - A prospective Cohort Study. Resusc Plus. 2021 Mar 06;6:100094. doi: 10.1016/j.resplu.2021.100094. eCollection 2021 Jun. PMID: 34223359; PMCID: PMC8244425.
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Resusc Plus. 2021 Mar 06;6:100094. doi: 10.1016/j.resplu.2021.100094. eCollection 2021 Jun.

Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS - A prospective Cohort Study.

Resuscitation plus

Romolo Gaspari, Justin Harvey, Christopher DiCroce, Ari Nalbandian, Michael Hill, Robert Lindsay, Alexandra Nordberg, Powell Graham, Andrew Kamilaris, Timothy Gleeson

Affiliations

  1. UMASS Memorial Medical Center, United States.
  2. Department of Emergency Medicine, UMASS Memorial Medical Center, United States.

PMID: 34223359 PMCID: PMC8244425 DOI: 10.1016/j.resplu.2021.100094

Abstract

OBJECTIVES: Pre-pause imaging during cardiopulmonary resuscitation (CPR) involves the acquisition of poor-quality, brief images immediately prior to stopping CPR to allow shorter, better-quality images during the pause. We hypothesize that pre-pause imaging is associated with a decrease in CPR pause length and shorter image acquisition time.

METHODS: Prospective, interventional cohort study enrolling out-of-hospital (OOH) cardiac arrest patients. Pre-pause imaging involves pre-localizing of the approximate sonographic window during CPR to support subsequent fine tuning when CPR pauses. Physicians were educated on pre-pause imaging and data was recorded prior- and post- introduction of pre-pause imaging into American cardiac life support (ACLS). Timing of CPR pauses and identification of interventions and events during pause were recorded (e.g., intubation, defibrillation, multiple cardiac ultrasounds). Ultrasound (US) images were reviewed for image quality using a 5-point scale. Primary outcome was length of CPR pause with and without pre-pause imaging. Secondary outcome included US length.

RESULTS: One hundred and forty five subjects presenting after OOH cardiac arrest were enrolled over 13 months, 70 during the baseline period prior to pre-pause imaging and 75 after pre-pause imaging was integrated into ACLS. Pre-pause imaging decreased CPR pause length from 28.3 s (95%CI 25.1-31.5) to 12.8 s (95%CI 11.9-13.7). US image acquisition time decreased with pre-pause imaging from 20.4 (95%CI 18.0-22.7) to 11.0 s (95%CI 10.1-11.8). US image quality was unchanged despite the decrease in image acquisition time. (3.0 (95%CI 2.8-3.2) vs 2.7 (95%CI 2.5-2.9)). Multivariate modeling showed that ultrasound did not prolong CPR pause length.

CONCLUSION: Pre-pause imaging was associated with significant decrease in CPR pause length and US image acquisition time. Pre-pause imaging should be encouraged for any clinicians who use ultrasound during ACLS.

© 2021 The Authors.

Keywords: 95%CI, 95% confidence intervals; ACLS, Advanced Cardiac Life Support; CPR, cardiopulmonary resuscitation; Cardiac arrest; ECG, electrocardiography; ED, emergency department; Echo, echocardiography; Echocardiography; OHCA, out of hospital cardiac arrest; Research methodology; Ultrasound image quality

Conflict of interest statement

None declared.

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