Many medical professionals are likely familiar with the unfortunate depictions of cardiopulmonary resuscitation (CPR) in Hollywood. A character drowns, is electrocuted, falls out of a building, or suffers some vicious fate and lands moments away from death. A loved one rushes to their aid and begins slapping, punching, or beating the afflicted before administering a romantic rescue breath that revives the victim. Together, they dive back into the action.
Those who see through the cinematic dramatization may roll their eyes and move on, but what if accurate movie depictions of CPR could save lives?
The reality is that about 436,000 individuals die from cardiac arrest in the United States each year. Though CPR is a valuable tool for increasing the chance of survival, many don’t receive the help they need, and even when they do, not everyone survives. Two routes must be taken to decrease fatality. One is to increase the number of civilians knowledgeable and confident enough to resuscitate victims, and the other is to improve the options available to support those already trained.
Lifeguards, teachers, flight attendants, and many more must receive CPR certification to be able to assist in case of an emergency. The CDC notes that about 9 in 10 people who enter cardiac arrest outside the hospital die. Placing trained personnel in key populated areas can help lower fatalities, but the CDC also encourages any able bystander to perform chest compressions regardless of certification or training.
Keeping oxygenated blood traveling to vital organs is the key to survival, and by manually pumping the heart, onlookers can save the victim’s life. To do so, they should press down about two inches into the center of the chest at 100 chest compressions per minute until a professional arrives on the scene to take over. This knowledge alone could be the difference between life and death because many don’t realize it’s better to try than to do nothing at all.
The chances of survival are significantly higher for patients who enter cardiac arrest in the hospital. They are surrounded by healthcare professionals who can effectively administer CPR, state-of-the-art equipment, and necessary medications and treatments. But the survival of in-hospital cardiac arrest is still as low as 25%.
Point-of-care ultrasound (POCUS) is a tool that could be the difference between life and death for patients receiving CPR. The handheld tool provides real-time insight into the physiology of resuscitation. Though POCUS should absolutely not interrupt or interfere with chest compressions, it can still be utilized to monitor the effectiveness of the procedure and examine the potential causes of cardiac arrest. This knowledge is critical.
Cardiac tamponade and pulmonary embolism (PE) are potentially reversible causes of cardiac arrest if identified quickly and appropriately treated. The SESAME-protocol can be applied and used during CPR without disrupting resuscitation. POCUS is instrumental in detecting the presence or absence of cardiac activity and guiding decision-making while continuing with CPR or initiating other treatments.
This bedside tool can help identify a true asystole from a false one or assist in predicting short-term cardiac resuscitation outcomes. Overall, POCUS is key to being as informed as possible about the emergency at hand. Just as the public must be educated on the basics of CPR to improve the survival rate of out-of-hospital cardiac arrests, so must medical staff become more educated about each emergency they respond to. Every patient’s body is different, and every situation is unique, so relying on outward signs of responsiveness should not be the standard.
POCUS is the key to knowledge for clinicians and survival for patients. Use it to open the door and move forward.
Interested in learning more about the benefits of POCUS in a cardiac emergency? Check out this blog to understand the need for POCUS awareness and education.