The use of critical care echocardiography in peri-arrest and cardiac arrest scenarios: Pros, cons and what the future holds

Abstract

Echocardiography is being increasingly deployed as a diagnostic and monitoring tool in the critically ill. This rise in popularity has led to its recommendation as a core competence in intensive care, with several training routes available. In the peri-arrest and cardiac arrest population, point of care focused echocardiography has the potential to transform patient care and improve outcomes. Be it via diagnosis of shock aetiology and reversibility or assessing response to treatment and prognostication. This narrative review discusses current and future applications of echocardiography in this patient group and provides a structure with which one can approach such patients.

Keywords: Echocardiography; anaesthesia; critical care; focused echocardiography; intensive care.

Figure 1.

Echocardiographic views of a pericardial effusion (i) A4C view of a pericardial effusion with RA collapse, (ii) PSAX view of a pericardial effusion, (iii) SC view of a pericardial effusion and thrombus (courtesy of thepocusatlas.com). PF: pericardial fluid; T: thrombus.

Figure 2.

Echocardiographic signs of PE (i) PLAX view – dilated RV with septal bowing, (ii) PSAX view – dilated RV with septal bowing, (iii) apical five chamber view – McConnell's sign.

Figure 3.

Echo-Guided Life Support algorithm – a proposed approach to the peri-arrest patient. Reproduced with the permission of Professor Jean-François Lanctôt.

Figure 4.

Suggested approach to the use of echocardiography in cardiac arrest, adapted from the FEEL protocol. Emphasis should be places on rapid and efficient scanning to ensure minimal interruption to compressions.