A novel hands-free carotid ultrasound detects low-flow cardiac output in a swine model of pulseless electrical activity arrest.

OBJECTIVE: To determine if a hands-free, noninvasive Doppler ultrasound device can reliably detect low-flow cardiac output by measuring carotid artery blood flow velocities. We compared the ability of observers to detect carotid artery flow velocity differences between pseudo-pulseless electrical activity (PEA) and true-PEA cardiac arrest. METHODS: Five swine were instrumented with aortic (Ao) and right atrial pressure-transducing catheters. The Doppler ultrasound device was adhered to the neck over the carotid artery. Continuous electrocardiogram, pressure readings, and Doppler signal were recorded. Each swine underwent multiple episodes of fibrillation and resuscitation. Episodes of true-PEA and pseudo-PEA were retrospectively identified from all resuscitation attempts by examination of electrocardiogram and Ao waveforms. The sensitivity and specificity of the device to detect pseudo-PEA was obtained using observers blinded to Ao waveform recordings. RESULTS: There was good interobserver reliability related to identification of pseudo- and true-PEA (κ = 0.873). The observers blinded to Ao waveform recordings agreed on 8 of the 9 episodes of pseudo-PEA, whereas 4 false positives of 26 true-PEA events were reported (sensitivity, 0.89; specificity, 0.85). The Doppler device was able to detect carotid flow velocity over a wide range of Ao blood pressures. CONCLUSIONS: This hands-free, noninvasive Doppler ultrasound device can reliably differentiate pseudo-PEA from true-PEA during resuscitation from cardiac arrest, detecting pressure gradient changes of less than 5 mm Hg through to normotension. This device distinguishes conditions of no cardiac output from low cardiac output and may have applications for use during resuscitation from various etiologies of arrest and shock.

Non-invasive continuous cerebral temperature monitoring in patients treated with mild therapeutic hypothermia: an observational pilot study.

AIM OF THE STUDY: To investigate if body temperature as measured with a prototype of a non-invasive continuous cerebral temperature sensor using the zero-heat-flow method to reflect the oesophageal temperature (core temperature) during mild therapeutic hypothermia after cardiac arrest. METHODS: In patients over 18 years old with restoration of spontaneous circulation after cardiac arrest, a temperature sensor that uses the zero-heat-flow principle was placed on the forehead during the periods of cooling and re-warming. This temperature was compared to oesophageal temperature as the primary temperature-monitoring site. To assess agreement, we used the Bland-Altman approach and Lin's concordance correlation coefficient. RESULTS: From September 2008 to April 2009, data from 19 patients were analysed. The median time from restoration of spontaneous circulation until temperature sensor application was 53min (interquartile range, 31; 96). All sensors were removed when a core temperature of 36 degrees C was reached. These measurements were in agreement with oesophageal temperature measurements. No allergic reaction, rash or other irritation occurred on the skin around or under the probes. Bland-Altman results showed a bias of -0.12 degrees C and 95% limits of agreement of -0.59 and +0.36 degrees C. Lin's concordance correlation coefficient was 0.98. CONCLUSIONS: Body temperature measurements using a non-invasive continuous cerebral temperature sensor prototype that uses the zero-heat-flow method accurately reflected oesophageal temperature measurements during mild therapeutic hypothermia in patients with restoration of spontaneous circulation after cardiac arrest.

An automated carotid pulse assessment approach using Doppler ultrasound.

During cardiac arrest emergencies, lay rescuers are required to manually check the patient's carotid pulse after the delivery of defibrillation shocks to assess the cardiac resuscitation progress of the patient. As a more automated way of monitoring the resuscitation progress, a new Doppler-ultrasound-based carotid pulse assessment approach is presented in this paper. The method works by analyzing the temporal aperiodicity of Doppler shifts seen in the ultrasound echoes returned from the patient's carotid arteries. As a quantitative investigation with this method, we derived a new measure called the pulselessness indicator to assess whether a carotid pulse is absent based on the given Doppler information. To study the performance of the new carotid pulse checking method, we built a multi-channel CW Doppler prototype device to acquire Doppler data in vivo during cardiac arrest experiments conducted on five different swines and computed pulselessness indicator estimates with these data. Our results indicated that the Doppler-based pulse checking approach has good sensitivity and specificity: it had a pulselessness detection rate greater than 0.9 for a given false alarm rate of 0.05. As a further analysis, the prototype device was applied to other experiments where the swine had suffered cardiac arrest for over five minutes. It showed a consistent assessment performance on the monitoring of the swine's resuscitation progress after defibrillation and chest compressions.