Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states

Vivek S. Tayal, Jeffrey Kline

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Objectives: Emergency echocardiography (EM echo) has been proposed to assist in decision-making in patients with pulseless electric activity (PEA) or PEA-like states. We observed the value of EM echo by emergency physicians in detecting pericardial effusion in patients in PEA and near PEA states. Materials and methods: Observational, prospective series at a Level 1 urban ED of patients with non-traumatic PEA or near PEA states who had EM echoes performed by emergency physicians during an 18-month period. Outcomes of patients with EM echoes were established by review of clinical course, formal echocardiography, radiography, operation or autopsy. Results: Twenty patients had EM echo for non-traumatic hemodynamic collapse. Eight of 20 patients (40%) were without cardiac ventricular motion and were refractory to ACLS measures. Twelve of 20 (60%) patients had cardiac kinetic motion observed on echo. Eight of the 12 (67%) patients with cardiac motion had a pericardial effusion observed on EM echo. Formal echocardiography or other imaging studies confirmed all pericardial effusion cases. The following diagnoses were subsequently confirmed in patients with pericardial effusion: one aortic aneurysm, two aortic dissections, two metastatic cancers, one post-dialysis effusion, two minimal effusions. Three patients had tamponade with emergency pericardial drainage or surgery. In two of four patients with cardiac activity without pericardial effusion, EM echo was useful by detecting pacer capture and ROSC, respectively. Conclusions: Emergency echocardiography performed by emergency physicians in patients in PEA or near PEA states can detect pericardial effusions with correctable etiologies versus true PEA with ventricular standstill.

Original languageEnglish (US)
Pages (from-to)315-318
Number of pages4
JournalResuscitation
Volume59
Issue number3
DOIs
StatePublished - Dec 2003
Externally publishedYes

Fingerprint

Pericardial Effusion
Echocardiography
Emergencies
Physicians
Aortic Aneurysm
Radiography
Dissection
Dialysis
Drainage
Autopsy
Decision Making
Hemodynamics

Keywords

  • Cardiac
  • Echocardiography
  • Emergent
  • PEA
  • Pericardial effusion
  • Ultrasound

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states. / Tayal, Vivek S.; Kline, Jeffrey.

In: Resuscitation, Vol. 59, No. 3, 12.2003, p. 315-318.

Research output: Contribution to journalArticle

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abstract = "Objectives: Emergency echocardiography (EM echo) has been proposed to assist in decision-making in patients with pulseless electric activity (PEA) or PEA-like states. We observed the value of EM echo by emergency physicians in detecting pericardial effusion in patients in PEA and near PEA states. Materials and methods: Observational, prospective series at a Level 1 urban ED of patients with non-traumatic PEA or near PEA states who had EM echoes performed by emergency physicians during an 18-month period. Outcomes of patients with EM echoes were established by review of clinical course, formal echocardiography, radiography, operation or autopsy. Results: Twenty patients had EM echo for non-traumatic hemodynamic collapse. Eight of 20 patients (40{\%}) were without cardiac ventricular motion and were refractory to ACLS measures. Twelve of 20 (60{\%}) patients had cardiac kinetic motion observed on echo. Eight of the 12 (67{\%}) patients with cardiac motion had a pericardial effusion observed on EM echo. Formal echocardiography or other imaging studies confirmed all pericardial effusion cases. The following diagnoses were subsequently confirmed in patients with pericardial effusion: one aortic aneurysm, two aortic dissections, two metastatic cancers, one post-dialysis effusion, two minimal effusions. Three patients had tamponade with emergency pericardial drainage or surgery. In two of four patients with cardiac activity without pericardial effusion, EM echo was useful by detecting pacer capture and ROSC, respectively. Conclusions: Emergency echocardiography performed by emergency physicians in patients in PEA or near PEA states can detect pericardial effusions with correctable etiologies versus true PEA with ventricular standstill.",
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