Prehospital echocardiography during CPR impacts treatment decisions in a Dutch physician-staffed helicopter emergency medical service

Aim Patients in cardiac arrest must receive algorithm-based management such as basic life support and advanced (cardiac) life support (ALS). International guidelines dictate diagnosing and treating any factor that may have caused the arrest or may be complicating the resuscitation. 1 Ultrasound is recognised to be of potential value in this process and can be used in a prehospital setting. 2 We aim to evaluate the use of prehospital echocardiography during CPR and its impact on treatment decisions in a Dutch helicopter emergency medical service (HEMS). Method From February 2014 through November 2016 we conducted an observational study in cardiac arrest patients, of any cause, in whom the Nijmegen HEMS performed CPR with concurrent echocardiography. The physicians adhered to ALS algorithms. Echocardiography was performed simultaneously with interruptions of chest compressions to allow for heart rhythm analysis. Results In 56 patients 102 ultrasound examinations were documented. Treatment decisions were impacted in 49 patients (88%) and in 62 (61%) ultrasound examinations. Overall, we found 78 changes. The changes were termination of CPR in 32 patients (57%) and continuation hereof in 21 (38%). Other changes were related to fluid management (14%), adjustment of drugs and doses (14%), and choice of receiving hospital (5%). Causes of cardiac arrest were trauma (48%), cardiac (21%), medical (14%), asphyxia (9%), and other (7%). Conclusion In conclusion, prehospital ultrasound during CPR in our HEMS significantly impacts patient treatment. Ultrasound images can help explain futile care to caregivers and relatives, even if the sensible decision already is to terminate CPR. References . Soar J, Nolan JP, Bottiger BW, Perkins GD, Lott C, Carli P, et al. European resuscitation council guidelines for resuscitation 2015: Section 3. Adult advanced life support. Resuscitation2015;95:100–47. . Breitkreutz R, Price S, Steiger HV, Seeger FH, Ilper H, Ackermann H, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: A prospective trial. Resuscitation2010;81(11):1527–33. Conflict of interest None Funding None