The proposal of an integrated ultrasonographic approach into the ALS algorithm for cardiac arrest: the PEA protocol

Background and Objective: Guidelines on cardiac arrest (CA) recommend the prompt beginning of cardio-pulmonary re- suscitation (CPR) and the identification and cor- rection of reversible causes. This article deals with the application of clinical ultrasonography (US) in resuscitation, presenting a simple codi- fied US protocol usable during CPR to recognize reversible causes of CA. Evidence on US in CA and State of the Art: Emergency US is a bedside, point-of-care, fo- cused diagnostic procedure with aim to com- plete the physical examination. It is performed by emergency physician everywhere to answer briefly important clinical questions. Several tri- als recently experimented US employment dur- ing advanced life support, demonstrating its fea- sibility without delaying CPR. Perspectives: the PEA Protocol: We p ro- pose a simplified US protocol for non-shock- able rhythms, called "PEA protocol" to remem- ber the applications of the study (CA in Pulse- less Electrical Activity, PEA) and the US scan sequence: Pulmonary scans to depict pneu- mothorax and pleural effusion and to differen- tiate wet or dry lung; Epigastric for pericardial effusion, left and right ventricular sides and motion, IVC filling; Abdominal and other scans for aortic aneurism and dissection, peritoneal effusion, bowel occlusion or perforation, deep venous thrombosis. The PEA protocol could be performed both during CA in PEA and during periarrest conditions. Conclusions: Clinical US, using a well codi- fied protocol, could effectively help to identify reversible causes in CA, even improving patients outcome.