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Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS – A prospective Cohort Study

OBJECTIVES: Pre-pause imaging during cardiopulmonary resuscitation (CPR) involves the acquisition of poor-quality, brief images immediately prior to stopping CPR to allow shorter, better-quality images during the pause. We hypothesize that pre-pause imaging is associated with a decrease in CPR pause...

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Autores principales: Gaspari, Romolo, Harvey, Justin, DiCroce, Christopher, Nalbandian, Ari, Hill, Michael, Lindsay, Robert, Nordberg, Alexandra, Graham, Powell, Kamilaris, Andrew, Gleeson, Timothy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244425/
https://www.ncbi.nlm.nih.gov/pubmed/34223359
http://dx.doi.org/10.1016/j.resplu.2021.100094
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author Gaspari, Romolo
Harvey, Justin
DiCroce, Christopher
Nalbandian, Ari
Hill, Michael
Lindsay, Robert
Nordberg, Alexandra
Graham, Powell
Kamilaris, Andrew
Gleeson, Timothy
author_facet Gaspari, Romolo
Harvey, Justin
DiCroce, Christopher
Nalbandian, Ari
Hill, Michael
Lindsay, Robert
Nordberg, Alexandra
Graham, Powell
Kamilaris, Andrew
Gleeson, Timothy
author_sort Gaspari, Romolo
collection PubMed
description OBJECTIVES: Pre-pause imaging during cardiopulmonary resuscitation (CPR) involves the acquisition of poor-quality, brief images immediately prior to stopping CPR to allow shorter, better-quality images during the pause. We hypothesize that pre-pause imaging is associated with a decrease in CPR pause length and shorter image acquisition time. METHODS: Prospective, interventional cohort study enrolling out-of-hospital (OOH) cardiac arrest patients. Pre-pause imaging involves pre-localizing of the approximate sonographic window during CPR to support subsequent fine tuning when CPR pauses. Physicians were educated on pre-pause imaging and data was recorded prior- and post- introduction of pre-pause imaging into American cardiac life support (ACLS). Timing of CPR pauses and identification of interventions and events during pause were recorded (e.g., intubation, defibrillation, multiple cardiac ultrasounds). Ultrasound (US) images were reviewed for image quality using a 5-point scale. Primary outcome was length of CPR pause with and without pre-pause imaging. Secondary outcome included US length. RESULTS: One hundred and forty five subjects presenting after OOH cardiac arrest were enrolled over 13 months, 70 during the baseline period prior to pre-pause imaging and 75 after pre-pause imaging was integrated into ACLS. Pre-pause imaging decreased CPR pause length from 28.3 s (95%CI 25.1–31.5) to 12.8 s (95%CI 11.9–13.7). US image acquisition time decreased with pre-pause imaging from 20.4 (95%CI 18.0–22.7) to 11.0 s (95%CI 10.1–11.8). US image quality was unchanged despite the decrease in image acquisition time. (3.0 (95%CI 2.8–3.2) vs 2.7 (95%CI 2.5–2.9)). Multivariate modeling showed that ultrasound did not prolong CPR pause length. CONCLUSION: Pre-pause imaging was associated with significant decrease in CPR pause length and US image acquisition time. Pre-pause imaging should be encouraged for any clinicians who use ultrasound during ACLS.
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spelling pubmed-82444252021-07-02 Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS – A prospective Cohort Study Gaspari, Romolo Harvey, Justin DiCroce, Christopher Nalbandian, Ari Hill, Michael Lindsay, Robert Nordberg, Alexandra Graham, Powell Kamilaris, Andrew Gleeson, Timothy Resusc Plus Clinical Paper OBJECTIVES: Pre-pause imaging during cardiopulmonary resuscitation (CPR) involves the acquisition of poor-quality, brief images immediately prior to stopping CPR to allow shorter, better-quality images during the pause. We hypothesize that pre-pause imaging is associated with a decrease in CPR pause length and shorter image acquisition time. METHODS: Prospective, interventional cohort study enrolling out-of-hospital (OOH) cardiac arrest patients. Pre-pause imaging involves pre-localizing of the approximate sonographic window during CPR to support subsequent fine tuning when CPR pauses. Physicians were educated on pre-pause imaging and data was recorded prior- and post- introduction of pre-pause imaging into American cardiac life support (ACLS). Timing of CPR pauses and identification of interventions and events during pause were recorded (e.g., intubation, defibrillation, multiple cardiac ultrasounds). Ultrasound (US) images were reviewed for image quality using a 5-point scale. Primary outcome was length of CPR pause with and without pre-pause imaging. Secondary outcome included US length. RESULTS: One hundred and forty five subjects presenting after OOH cardiac arrest were enrolled over 13 months, 70 during the baseline period prior to pre-pause imaging and 75 after pre-pause imaging was integrated into ACLS. Pre-pause imaging decreased CPR pause length from 28.3 s (95%CI 25.1–31.5) to 12.8 s (95%CI 11.9–13.7). US image acquisition time decreased with pre-pause imaging from 20.4 (95%CI 18.0–22.7) to 11.0 s (95%CI 10.1–11.8). US image quality was unchanged despite the decrease in image acquisition time. (3.0 (95%CI 2.8–3.2) vs 2.7 (95%CI 2.5–2.9)). Multivariate modeling showed that ultrasound did not prolong CPR pause length. CONCLUSION: Pre-pause imaging was associated with significant decrease in CPR pause length and US image acquisition time. Pre-pause imaging should be encouraged for any clinicians who use ultrasound during ACLS. Elsevier 2021-03-06 /pmc/articles/PMC8244425/ /pubmed/34223359 http://dx.doi.org/10.1016/j.resplu.2021.100094 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Paper
Gaspari, Romolo
Harvey, Justin
DiCroce, Christopher
Nalbandian, Ari
Hill, Michael
Lindsay, Robert
Nordberg, Alexandra
Graham, Powell
Kamilaris, Andrew
Gleeson, Timothy
Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS – A prospective Cohort Study
title Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS – A prospective Cohort Study
title_full Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS – A prospective Cohort Study
title_fullStr Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS – A prospective Cohort Study
title_full_unstemmed Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS – A prospective Cohort Study
title_short Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS – A prospective Cohort Study
title_sort echocardiographic pre-pause imaging and identifying the acoustic window during cpr reduces cpr pause time during acls – a prospective cohort study
topic Clinical Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244425/
https://www.ncbi.nlm.nih.gov/pubmed/34223359
http://dx.doi.org/10.1016/j.resplu.2021.100094
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