![]() ![]() After this initial screening, full-text articles were assessed for eligibility. All titles and abstracts were screened for their relevance. The database was searched from inception until October 2019. Search StrategyĪ systematic literature search of the PubMed database was performed (Fig. This study reviews the current literature regarding the available diagnostic tools in a prehospital setting and their application and interpretation during a CA with pulseless electric activity as initial rhythm. Finally, portable cerebral oxygenation monitoring devices have become a hot topic in research on OHCA. Ultrasonography has the potential to become an important asset in CA settings as well, even more so since the development of wireless, handheld devices. A magnitude of studies have been conducted on its usefulness and its ability to predict return of spontaneous circulation (ROSC). Another tool that has been used extensively to monitor OHCAs is capnography. Several studies have been published investigating the usefulness of QRS characteristics on ECG to discriminate between groups of causal mechanisms. Not only are these tools helpful in detecting an underlying cause, they can also assist emergency physicians in clinical decision-making by determining the expected prognosis. Over the last few years, technology has improved and an increasing number of diagnostic tools have become available for use in a prehospital CA setting. Comparative studies are required to identify the best ultrasonographic protocol, which can be included in resuscitation guidelines. Ultrasonographic evaluation should be performed subsequently, both for detecting an underlying cause and discriminating between true PEA and pseudo PEA. In the management of OHCA, anamnestic and clinical information remains the initial source of information in search for an underlying cause. Although evidence about the prognostic potential of cerebral oximetry in OHCA is accumulating, its diagnostic potential is still unknown. Multiple studies describe a prognostic potential. Limited evidence suggests a role for point-of-care testing in detecting hyperkalemia and a role for capnography in the diagnosis of asphyxia CA. ![]() Further research concerning the relationship between electrocardiogram characteristics and underlying causes is required. There are currently no studies comparing these protocols regarding their feasibility and their effect on patient survival. Ultrasonography has become a great asset in detecting underlying causes, and a variety of protocols have been proposed. Articles were assessed for eligibility by title, abstract, and full text. A systematic literature search of the PubMed database was performed. The aim of this study was to review the diagnostic tools available in a prehospital setting, and their interpretation during cardiac arrest (CA) with PEA as initial rhythm. This often poses a challenge in the chaotic prehospital environment with only limited resources available. PEA should be managed by identifying the underlying cause of the arrest and treating it accordingly. The proportion of out-of-hospital cardiac arrests (OHCAs) with pulseless electrical activity (PEA) as initial rhythm is increasing.
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