Zafiropoulos Andreas, Asrress Kaleab, Redwood Simon, Gillon Stuart, Walker David
Anaesthetics and Intensive Care, St Bartholomew's Hospital , London , UK.
Cardiology, St Thomas' Hospital , London , UK ; King's Health Partners , London , UK.
Echo Res Pract. 2014 Dec 1;1(2):D15-21. doi: 10.1530/ERP-14-0052. Epub 2014 Oct 9.
Management of medical cardiac arrest is challenging. The internationally agreed approach is highly protocolised with therapy and diagnosis occurring in parallel. Early identification of the precipitating cause increases the likelihood of favourable outcome. Echocardiography provides an invaluable diagnostic tool in this context. Acquisition of echo images can be challenging in cardiac arrest and should occur in a way that minimises disruption to cardiopulmonary resuscitation (CPR). In this article, the reversible causes of cardiac arrest are reviewed with associated echocardiography findings.
A 71-year-old patient underwent right upper lobectomy for lung adenocarcinoma. On the 2nd post-operative day, he developed respiratory failure with rising oxygen requirement and right middle and lower lobe collapse and consolidation on chest X-ray. He was commenced on high-flow oxygen therapy and antibiotics. His condition continued to deteriorate and on the 3rd post-operative day he was intubated and mechanically ventilated. Six hours after intubation, he became suddenly hypotensive with a blood pressure of 50 systolic and then lost cardiac output. ECG monitoring showed pulseless electrical activity. CPR was commenced and return of circulation occurred after injection of 1 mg of adrenaline. Focused echocardiography was performed, which demonstrated signs of massive pulmonary embolism. Thrombolytic therapy with tissue plasminogen activator was given and his condition stabilised.
医疗性心脏骤停的管理具有挑战性。国际公认的方法高度规范化，治疗与诊断并行进行。尽早识别诱发原因可增加获得良好预后的可能性。在此背景下，超声心动图提供了一种极有价值的诊断工具。在心脏骤停时获取超声图像可能具有挑战性，应以尽量减少对心肺复苏（CPR）干扰的方式进行。在本文中，我们回顾了心脏骤停的可逆性病因及相关的超声心动图表现。
一名71岁患者因肺腺癌接受了右上叶切除术。术后第2天，他出现呼吸衰竭，氧需求增加，胸部X线显示右中、下叶肺不张和实变。他开始接受高流量氧疗和抗生素治疗。他的病情持续恶化，术后第3天进行了气管插管和机械通气。插管6小时后，他突然出现低血压，收缩压为50，随后心输出量丧失。心电图监测显示无脉电活动。开始进行心肺复苏，注射1毫克肾上腺素后恢复了循环。进行了床旁超声心动图检查，结果显示存在大面积肺栓塞的迹象。给予组织纤溶酶原激活剂进行溶栓治疗后，他的病情稳定下来。
