So just wanted to briefly review POCUS technique during arrest. What I like to do is to position my probe for a subxiphoid view while CPR is ongoing, and try to see what I can. It may look like this:
The best is to record a loop and review it immediately, in order to be able to focus properly on each important area and let CPR continue. For instance, in the clip above, there is a lot of information. There is a pericardial effusion, but clearly visible cardiac chambers make tamponade as the sole reason of the arrest unlikely (atrial pressures > pericardial pressure). The RV is not huge and crushing the LV, so massive PE – although not ruled out – probably isn’t the cause of arrest.
Be wary, however, of making calls based on RV appearance or RV to LV ratios as representing PE in a nonbeating heart, as this is not necessarily representative of the state of the RV or RV/LV ratio immediately pre-arrest.
More Posts to come on the topic of peri-arrest POCUS…
For more POCUS tips, see here!