ECHO in Cardiac Arrest Resuscitative Cardiac Care
Introduction
Point-of-care transthoracic echocardiography (TTE/POCUS) is a focused, goal-directed adjunct during adult advanced life support.
When performed by trained operators and integrated into choreographed pauses it can rapidly identify potentially reversible causes (for example, tamponade, massive pulmonary embolism, hypovolaemia), detect organised cardiac motion (prognostic information), and direct immediate management or escalation.
The overriding principle in UK guidance is that ultrasound must never prolong chest-compression interruptions; operators must be competent and scans must be planned into existing rhythm/pulse checks (RCUK ALS; FEEL course materials).
Indications and aims
- Rapidly detect reversible causes that would change immediate management: large pericardial effusion/tamponade, signs suggestive of massive pulmonary embolism (marked right ventricular dilation/strain), severe left ventricular dysfunction, very small hyperdynamic ventricles suggesting hypovolaemia, and pneumothorax (with lung POCUS) (RCUK Special Circumstances).
- Determine presence or absence of organised cardiac motion to help prognostication and guide continuation/termination conversations - findings must be interpreted in context and not used in isolation (RCEM TCA guidance).
- After sustained return of spontaneous circulation (ROSC), provide early formal TTE to identify underlying pathology, quantify dysfunction and inform decisions about angiography or mechanical circulatory support/ECPR (RCUK post-resuscitation guidance; NICE HTG765).
Who should perform intra-arrest echo
- Only clinicians with appropriate training and local credentialling should perform intra-arrest TTE.