DETECTION OF TRAUMATIC COMPLICATIONS OF CARDIOPULMONARY-RESUSCITATIONBY ULTRASOUND

Study objective: We conducted a pilot study to assess the feasibility of ultrasonography in the detection of traumatic complications of CPR. Methods: A prospective case series was undertaken with a convenience sample of 21 emergency department patients who sustained nontraumatic cardiopulmonary arrest. A 5- to 7-minute ultrasound examination was pe rformed during resuscitation. The presence or absence of free fluid wa s noted in the left and right upper quadrants, coronal views of the ki dneys, the pelvis, and the pericardium; autopsies to determine the sou rce of fluid were not performed. Cardiac activity and the concurrent e lectrical rhythm were also noted. All ultrasonographers had previously been trained in the use of this technique for the evaluation of traum a patients. Examinations were stored on videotape for further review. Results: Seven of 20 patients (29%) had findings on ultrasound that co uld have resulted from CPR-related trauma. in one additional case, fin dings of free fluid were probably the result of preexisting illness (a scites). Pericardial effusion was found in three patients, perihepatic fluid in four, pleural fluid in one, perirenal fluid in four, perispl enic fluid in two, and pelvic fluid in three; several patients had mul tiple findings. Cardiac motion with pulseless electrical activity was noted in seven patients. Five patients had return of spontaneous circu lation and survived to hospitalization, and one survived to discharge. Conclusion: Traumatic complications of CPR are well known but typical ly difficult to assess. Ultrasonography may identify injuries, help gu ide procedures, and serve as a means to assess pharmacologic effects o n cardiac performance during CPR. It is a readily available, noninvasi ve means to assess these critically ill patients.