Search for Structural Cardiac Abnormalities Following Sudden Cardiac Arrest Using Post-mortem Echocardiography in the Emergency Department: A Preliminary Study

ABSTRACT

PURPOSE: Sudden cardiac arrest (SCA) accounts for approximately 15% of all-cause mortality in the US and 50% of all cardiovascular mortalities in developed countries; 10% of cases have an underlying structural cardiac abnormality. An echocardiography has widely been used to evaluate cardiac abnormality, but it needs to be performed by emergency physicians available in the emergency department immediately after death, rather than by cardiologists. We aimed to determine whether post-mortem echocardiography (PME) performed in the emergency department may reveal such abnormalities. METHODS: We evaluated the reliability and validity of PME performed by emergency physicians in the emergency department. Measurement by a cardiologist was used as reference. RESULTS: Two emergency physicians performed PME on 3 out of the 4 included patients who died after unsuccessful cardiopulmonary resuscitation. PME was started within 10 minutes of death, and it took 10 minutes to complete. Parasternal views in either supine or left decubitus position were most helpful. The adequacy of the image was rated good to fair, and that of measurements was acceptable to borderline. Regarding the chamber size and left ventricular wall thickness, intraclass correlation coefficients for reliability and validity were 0.97 (n=15) and 0.95 (n=35), respectively (p<0.001). Evaluation of presence/absence of left ventricular wall thinning, valve calcification, and pericardial effusion was incomplete (3/7-5/7), precluding further analysis. CONCLUSION: Emergency physicians could perform reliable and valid PME to assess the chamber size and left ventricular wall thickness. A large prospective study with collaboration between emergency physicians and cardiologists would reveal the feasibility and usefulness of PME in diagnosing structural causes of sudden cardiac arrest.