3. Anile

RIANIMAZIONE
CARDIOPOLMONARE
Il ruolo dell’Ecografia
A. ANILE
RIANIM OVE-POLICL CT
Nuove linee Guida (2015) !!!
J. Soar et al. Resuscitation 95 (2015) 100–147
J. Soar et al. Resuscitation 95 (2015) 100–147
Ultrasuoni in ACR:
si può?
Recommended:
“high-quality cardiopulmonary
resuscitation with minimal
interruptions to reduce the no-flow
intervals”
American Heart Association/European Resuscitation Council/
International Liaison Committee on Resuscitation guidelines
4 Fasi
• 
CPR e preparazione
•  Esecuzione dell’ecografia
•  Ripresa della CPR
•  Interpretazione comunicazione e
conseguenze
The integration of ultrasound into advanced life support
requires considerable training if interruptions to chest
compressions are to be minimised. A sub-xiphoid probe position
has been recommended. Placement of the probe just before chest
compressions are paused for a planned rhythm assessment
enables a well-trained operator to obtain views within 10 s.
Absence of cardiac motion on sonography during resuscitation
of patients in cardiac arrest is highly predictive of death
although sensitivity and specificity has not been reported.
Ultrasuoni in ACR
Come integrarli
Ultrasuoni in ACR
• 
Differenzia una Vera PEA da una Pseudo PEA • 
• 
Rileva precocemente un “ROSC”
Identifica precocemente molte delle cause
reversibili di ACR:
• 
Tamponamento cardiaco
• 
• 
• 
Ipovolemia
Embolia polmonare
Disfunzione (anche regionale) del Ventr. Sx
• 
Pnx
ACR- Vera PEA
PSEUDO-PEA
PA n.r
PEA-Pseudo PEA?
58%
Breitkreutz R, Price S, Steiger HV, et al. Resuscitation 2010.
IPOVOLEMIA
C’è PNX?
Il polmone è a parete?
4) TVP
TAMPONAMENTO
CONCLUSIONI
GRAZIE