POCUS in cardiac arrest
The PULSE Protocol was developed to incorporate POCUS into pediatric resuscitation. The authors suggest 4 areas in which POCUS can be used as an adjunct, emphasizing that this should only be implemented when the user has sufficient expertise and sufficient help so they don't get distracted from actually running the resuscitation.
- Central vessel assessment: during compressions, using color doppler a linear probe can be placed over the carotid or femoral artery to assess effectiveness of compressions. During pulse checks, the probe can be left in the same area to check for the presence of a pulse.
- Cardiac assessment: during pulse checks, a phased-array (cardiac) probe can be utilized to evaluate for organized cardiac activity. Importantly, this should not take >10 seconds. I'd recommend finding a good window, hitting the "Record" button, and reviewing the video after compressions have resumed so as not to get stuck trying to evaluate the images in real time, delaying compressions. The authors also say the cardiac assessment can be used during compressions to find the optimal hand position (help to identify area directly over the LV). Given the relatively small size of our patients, plus adult hands doing the compressions, plus a defibrillator pad and other cardiac monitoring in place, I'm not sure of there's any real utility here.
- Reversible causes: things like tamponade, PE, tension pneumothorax, and hypovolemia can be assessed during the resuscitation. Importantly, if an ETT is present, it has to be in the correct position (not the right mainstem) for lung sliding to occur when evaluating for pneumothorax.
- POCUS can confirm placement of an IO (doppler flow seen below cortex just proximal to IO placement) and ETT (linear probe over the anterior neck can differentiate esophageal versus tracheal placement)
