Page 171 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
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                 Prehospital echocardiography during resuscitation impacts treatment in a physician-staffed HEMS 169
Introduction
Patients suffering from cardiac arrest must be treated immediately using algorithm-based management such as basic life support (BLS) and advanced life support (ALS). International resuscitation guidelines stress the importance of diagnosing and treating any factor that may have caused the arrest or may be complicating the resuscitative effort.1–4 These guidelines recognize ultrasound to be of potential value in this process.
Peri-resuscitation ultrasound may be useful to identify treatable causes such as pericardi- al tamponade, cardiogenic shock, myocardial insufficiency, signs of pulmonary embolism, or hypovolemia.5,6 Moreover, it may differentiate between false and true pulseless electri- cal activity (PEA), a pulseless state respectively with or without any cardiac contractions. Detection of cardiac activity on ultrasound may be an early sign of return of spontaneous circulation (ROSC) and is a good predictor of survival.7,8
Previous studies have demonstrated the feasibility of the application of ultrasound during in-hospital and out-of-hospital cardiopulmonary resuscitation (CPR).9 Integrating it in cur- rent ALS algorithms is achievable while maintaining strict protocol adherence.10
Although the added value of ultrasound in ALS has been suggested, the question remains how it affects patient care and decision-making in the specific setting of a helicopter emer- gency medical service (HEMS). We sought to evaluate the use of prehospital ultrasound during traumatic and non-traumatic CPR and determine its impact on patient treatment in a Dutch HEMS.
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