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