Point of care ultrasound (POCUS) may be very useful during CPR, but it should not get in the way of chest compressions. If you’re going to use it, get in there quick and then get out of the way or choose a view that allows continuous chest compressions (i.e. subxiphoid).
Why does this matter?
Time off from doing chest compressions greatly reduces the effectiveness of CPR. ACLS/BLS recommends a maximum of 10 seconds off the chest for a pulse check. POCUS may prolong time off from doing chest compressions.
Sono or later
POCUS in arrest can come in handy to look for tamponade, massively dilated RV in PE, and for mechanical activity in PEA. But it can also get in the way of high quality CPR, most importantly chest compressions. This prospective study found that in video recordings of CPR at this single center, the average pause for a pulse check was 21 seconds when POCUS was used and only 13 seconds when it was not. This significantly degrades the effectiveness of CPR, and the harm from that likely outweighed any benefit that might have been gained from POCUS. However, this study did not assess patient-centered outcomes related to these longer pauses, so we don’t know how it actually affected ROSC or neurologically intact survival. This was a very small study of just 23 patients at a single center, so this may not reflect the practice at your facility.
Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation. 2017 Jul 25. pii: S0300-9572(17)30302-7. doi: 10.1016/j.resuscitation.2017.07.021. [Epub ahead of print]
Peer reviewed by Thomas Davis, MD.