Name: ultrasonographic assessment during cardiopulmonary resuscitation
Uploaded: 2020-10-24T15:00:00
Description: Watch this Scientific Journal Video about Ultrasonographic Assessment During Cardiopulmonary Resuscitation at JoVE.com

这项研究部分得到台湾科技部的资助（科技部103-2511-S-002-007）。作者要感谢吴志贤博士和宋仁志先生协助制作照片和电影。

该程序经台湾大学医院机构审查委员会批准，注册于ClinicalTrials.gov（NCT02952768）。
1. 仪器仪表
<ol><li>使用配备曲线 2~5 MHz 探头的美国机器。便携式美国更适合心肺复苏。</li>
</ol>2. 人员及其在复苏小组中的角色
<ol><li>理想情况下，复苏小组应由六名成员组成：1） 一名领导者;1） 一名领导者;1） 一名领导;1） 一名领导;1） 一名领导;1） 一名领导;1名领导;1名...

<ol>
	<li>Soar, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=European+Resuscitation+Council+Guidelines+for+Resuscitation+2015:+Section+3.+Adult+advanced+life+support.">European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support.</a> Resuscitation. 95, 100-147 (2015).</li><li>Takeda, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+assessment+of+three+methods+to+verify+tracheal+tube+placement+in+the+emergency+setting.">The assessment of three methods to verify tracheal tube placement in the emergency setting.</a> Resuscitation. 56 (2), 153-157 (2003).</li><li>Levine, R., Wayne, M., Miller, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=End-tidal+carbon+dioxide+and+outcome+of+out-of-hospital+cardiac+arrest.">End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest.</a> New England Journal of Medicine. 337, 301-306 (1997).</li><li>Moule, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Checking+the+carotid+pulse:+diagnostic+accuracy+in+students+of+the+healthcare+professions.">Checking the carotid pulse: diagnostic accuracy in students of the healthcare professions.</a> Resuscitation. 44 (3), 195-201 (2000).</li><li>Sitzwohl, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endobronchial+intubation+detected+by+insertion+depth+of+endotracheal+tube,+bilateral+auscultation,+or+observation+of+chest+movements:+randomised+trial.">Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial.</a> British Medical Journal. 341, 5943 (2010).</li><li>Monsieurs, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=European+Resuscitation+Council+Guidelines+for+Resuscitation+2015:+Section+1.+Executive+summary.">European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary.</a> Resuscitation. 95, 1-80 (2015).</li><li>Breitkreutz, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Focused+echocardiographic+evaluation+in+life+support+and+peri-resuscitation+of+emergency+patients:+a+prospective+trial.">Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial.</a> Resuscitation. 81 (11), 1527-1533 (2010).</li><li>Hernandez, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=C.A.U.S.E.:+Cardiac+arrest+ultra-sound+exam--a+better+approach+to+managing+patients+in+primary+non-arrhythmogenic+cardiac+arrest.">C.A.U.S.E.: Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest.</a> Resuscitation. 76 (2), 198-206 (2008).</li><li>Perera, P., Mailhot, T., Riley, D., Mandavia, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+RUSH+exam:+Rapid+Ultrasound+in+SHock+in+the+evaluation+of+the+critically+lll.">The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll.</a> Emergency Medicine Clinics of North America. 28 (1), 29-56 (2010).</li><li>Blyth, L., Atkinson, P., Gadd, K., Lang, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bedside+focused+echocardiography+as+predictor+of+survival+in+cardiac+arrest+patients:+a+systematic+review.">Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review.</a> Academic Emergency Medicine. 19, 1119-1126 (2012).</li><li>Lien, W. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=US-CAB+protocol+for+ultrasonographic+evaluation+during+cardiopulmonary+resuscitation:+validation+and+potential+impact.">US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: validation and potential impact.</a> Resuscitation. 127, 125-131 (2018).</li><li>Chou, H. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+tracheal+ultrasonography+for+confirmation+of+endotracheal+tube+placement+during+cardiopulmonary+resuscitation.">Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation.</a> Resuscitation. 84 (12), 1708-1712 (2013).</li><li>Sim, S. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonographic+lung+sliding+sign+in+confirming+proper+endotracheal+intubation+during+emergency+intubation.">Ultrasonographic lung sliding sign in confirming proper endotracheal intubation during emergency intubation.</a> Resuscitation. 83 (3), 307-312 (2012).</li><li>Lien, W. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+US-CAB+protocol+for+ultrasonographic+evaluation+during+cardiopulmonary+resuscitation.">A novel US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation.</a> Resuscitation. 115, 1-2 (2017).</li><li>Roelandt, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+stethoscopy.">Ultrasound stethoscopy.</a> European Journal of Internal Medicine. 15, 337-347 (2004).</li><li>Lien, W. C., Chang, W. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Potential+Pitfall+of+Tracheal+Ultrasound+for+the+Confirmation+of+Endotracheal+Intubations.">A Potential Pitfall of Tracheal Ultrasound for the Confirmation of Endotracheal Intubations.</a> Journal of Ultrasound in Medicine. , (2019).</li><li>Huis In't Veld, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+use+during+cardiopulmonary+resuscitation+is+associated+with+delays+in+chest+compressions.">Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions.</a> Resuscitation. 119, 95-98 (2017).</li><li>Clattenburg, E. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasound+use+in+patients+with+cardiac+arrest+is+associated+prolonged+cardiopulmonary+resuscitation+pauses:+A+prospective+cohort+study.">Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: A prospective cohort study.</a> Resuscitation. 122 (1), 65-68 (2018).</li><li>Lien, W. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Data+on+evaluation+of+proficiency+for+the+US-CAB+curriculum.">Data on evaluation of proficiency for the US-CAB curriculum.</a> Data in Brief. 16 (17), 965-968 (2017).</li><li>Lien, W. C., Chang, W. T., Ma, M. H., Chen, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonography+during+CPR:+Hands-off+or+hands-on.">Ultrasonography during CPR: Hands-off or hands-on.</a> Resuscitation. 125, 8-10 (2018).</li></ol>

美国是一种非侵入性、实时且随时可用的成像模式，适用于紧急和危重护理环境。在心肺复苏过程中，美国的应用在诊断、治疗干预指导或监测15方面起着重要作用。虽然许多美国协议已引入用于 CPR，但 US-CAB 协议符合高级生命支持 （ALS） 序列。它整合了美国的重要技术，以检测任何问题的可逆原因，并评估C-A-B状态在复苏的整个过程中11，14。,<sup clas...

有效的心肺复苏（CPR）心脏骤停是患者成功复苏的关键。循环 （C）、气道 （A） 和呼吸 （B） 是基本 （BLS） 或高级生命支持 （ALS） 中的三个关键组成部分。CPR期间C-A-B状态的评估基本上依赖于脉搏检查、检查和封顶1。然而，在真正的临床条件下，CPR通常是复杂和混乱的，这些方法可能有局限性,2，3。例如，即使由医疗保健提供商 4 执行，脉冲检查的准确性也往往不理想。如果仅由 5 的听样引导，一个肺插管中一半以上可能会被误导。即使是波帽造影，也受到心脏输出低、肺流量低、心肺在CPR2期间使用肾上腺素等因素的影响。因此，必须对 C-A-B 状态进行更有效、更准确的评估。
当试图寻找心脏骤停的病因或任何潜在的可逆因素在心肺复苏过程中，病史和体格检查往往是不够的。检测可逆原因，如5H（即缺氧、低血症、高钾血症/低钾血症、酸中毒和体温过低）和5Ts（即心脏棉布、张力肺炎、肺血栓栓塞、冠状动脉血栓形成和毒素或片剂），通常需要进行高级检查。
超声波（美国）是紧急情况和重症监护环境中的一种有用的成像方式。欧洲复苏理事会（ERC）指南建议，美国可以成为复苏6的一个组成部分。美国可以很容易地识别对心肺复苏产生负面影响的关键但潜在的可逆因素，如心脏棉布、肺血栓栓塞和低血症7，8，9。,8,9美国还帮助排除肺炎和急性冠状动脉综合征。此外，即使进行心肺复苏，美国也具有预知意义。据报道，在心肺复苏期间出现的松版心脏活动，使ROSC、存活率和出院10，11的机会增加。除了对心脏和循环状态的声像评估，气管美国被用来确认适当的气管插管12，而肺美国用于确认适当的双边肺通气13。
虽然高质量的CPR与最小的压缩中断是复苏最重要的因素，重要的是要了解如何无缝地将美国融入复苏过程，而不干扰CPR。因此，我们开发了一种符合ALS的PRS协议，用于CPR14。本文详细介绍了将美国协议更好地集成到常规CPR流程所需的设置、人员和仪器，一线医生可以轻松地将之纳入并实施到他们的实践中。

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			<td class="xl65" height="21" style="height:15.75pt;width:162pt" width="216">Ultrasound</td>
			<td class="xl65" style="width:140pt" width="186">Cannon, Japan</td>
			<td class="xl65" style="width:89pt" width="119">SSA-550A</td>
			<td class="xl66" style="width:125pt" width="167">nil</td>
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ultrasonographic assessment during cardiopulmonary resuscitation

US-CAB（超声、循环/气道/呼吸）协议将多种声象技术整合到以高级生命支持标准进行心肺复苏（CPR）期间患者循环、气道和呼吸状态的结构化评估中。US-C 提供心脏的亚西气向视图，以查找潜在的可逆疾病原因，如心包出血、肺栓塞、低发血症和急性冠状血栓。CPR 期间的神化心脏活动不仅有助于区分伪无脉冲电活动 （PEA） 和真正的 PEA，而且表示自发循环 （ROSC） 和生存的回归机会更高。对劣质静脉注射体（IVC）的评估显示患者的液体状态，并指明用于液体复苏的最佳方法。如果怀疑进行大动脉解剖，建议对大动脉进行次焦虑视图，以识别内部皮瓣。插管完成后，前体槽口的气管超声（US-A）有助于将气管内管插管（一个带一个彗尾的气粘膜界面）与食管插管（双道符号）区分开来。紧接着美国-A，双边肺美国（US-B）应做确认适当的双边通气使用肺滑动标志。此外，可以连续跟踪美国-C，查看心脏腔室和 IVC 的动态变化，或 ROSC 的任何心脏收缩暗示。US-B还可以检测共存的肺或胸膜病理，而不会干扰心肺复苏的表现。实施此方法时，主要关心的是在执行 US-CAB 时保持高质量的 CPR，而不会延迟胸部压缩。严格的培训和持续的实践是尽量减少复苏过程中任何中断的关键。

US-C对心脏进行亚西向评估，显示心脏四室视图，如图 3A所示。此时，可以检测三种典型模式中的任何一种，这些模式暗示了特定病因或可逆因素。
确定心包血福的存在和特征：如果存在心内输液，请注意右心室（即右心房甚至右心室）是否被压缩。如果注意到右心房和心室的压缩（图3A），则指示心包两难，应立即进行。如果没?...

Watch this Scientific Journal Video about Ultrasonographic Assessment During Cardiopulmonary Resuscitation at JoVE.com

Ultrasonographic Assessment During Cardiopulmonary Resuscitation

在这里，我们提出了一个美国-CAB（超声波，循环/气道/呼吸）协议，用于心肺复苏（CPR）。US-C 评估心脏和劣质的维纳卡瓦的亚西向视图。插管后，气管美（美-A）和肺美国（美-B）有助于确认气管内插管和适当通气。

心肺复苏期间的超分谱评估

The US-CAB (Ultrasound, Circulation/Airway/Breathing) protocol integrates several sonographic techniques into a structured assessment of the circulation, ...

US-CAB 协议是一种简单、结构化的协议，在复苏过程中使用。它是在高级生命支持指南中以 CAB 序列命名的。美国-CAB协议可以在复苏期间使用。它对患者结果有积极影响。理想情况下，复苏小组应包括一名领导、一名气道管理和通风人员、一名胸部压缩人员、一名除颤人员、一名静脉导管和药物成员以及一名记录器。超声医生还应作为团队的独立成员出席，该成员在复苏超声方面训练有素，经验丰富，并且能够及时干预和解释超声图像，而不会中断或延迟复苏工作。当超声波被集成到心肺复苏过程中时，在患者的考达尔区域放置一台便携式超声波机，并每两分钟为CPR设置一个警报，每10秒设置一次脉搏检查的报警器。将脉搏检查节奏分析的免提间隔限制为不超过10秒。在心肺复苏的开始和胸部压缩前五个周期结束时，使用下西气向四室视图检查心瓣、左右心室的大小以及声象心脏活动。然后转动探头90度，平行于患者的长轴，以测量劣质维纳卡瓦的直径。要检查插管后气管管的位置，请横向将探针放在超前缺口处，并注意与一个彗尾神器的一个气粘膜接口，用于气管插管。将探头移动到颈部的侧侧，以重新确认单路标志。再插管，如果有两个气粘膜接口与两个彗尾神器。要检查是否通风正常，请将探针放在胸部两侧，在中轴线上的第四至第五个间空间，并寻找肺滑动以评估肺通气。如果一侧没有肺滑动，则调整气管深度，直到注意到双边肺滑动。然后，当胸部压缩停止进行脉搏检查时，每两分钟重复一次心脏超声波检查。在患者运输和卧铺转移后，继续重复气道和呼吸超声波检查。如果在进行下西气向评估的心脏超声检查时注意到右心房和心室的压缩，则表明心包膜穿图，应立即进行。心血性输液也有诊断价值。如果回显性高或血块存在于心包糖中，病因可能表明严重的并发症。心脏超声与下西腓评估的劣质静脉卡瓦可以通过垂直方法证明，和视觉识别劣质静脉卡瓦直径有助于评估患者的液体状态。在亚西向横向视图中也可以评估劣质的维纳卡瓦。心脏超声与下海向量验证下降的腹部主动脉可以通过垂直或横向视图接近。如果怀疑从临床表现中进行大动脉解剖，或者通过心脏超声心脏评估观察到血红素，建议进行这种可选评估。如果观察到单个区域符号，将确认内路插管。如果有双道标志食管插管是极有可能的。呼吸超声通常在气道超声后立即进行，当进行麻醉或封顶术时，它也可以在CPR期间随时执行时，置换的气管管与一个肺插管怀疑或当特定的病因，如肺气管或赫莫塔克斯需要排除。尽管扫描序列是有组织的，但可以根据超声码师的经验更改顺序。专注训练和持续练习对于在胸部压缩期间尽量减少过程至关重要。保持良好的质量形象是进一步研究的重要问题。

Research

JoVE Journal

Medicine

Normothermic Cardiac Arrest and Cardiopulmonary Resuscitation: A Mouse Model of Ischemia-Reperfusion Injury

常温心脏骤停和心肺复苏术：缺血再灌注损伤的小鼠模型

Acute Kidney Injury (AKI) is a common, highly lethal, complication of critical illness which has a high mortality1-4 and which is most 
frequently caused ...

科研

医学

A Rat Model of Ventricular Fibrillation and Resuscitation by Conventional Closed-chest Technique

室颤由传统的封闭胸技术大鼠模型和复苏

A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic ...

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

肺毛细血管血量，膜弥散能力，及肺内动静脉吻合的评估期间行使

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

Cardiopulmonary Bypass in a Mouse Model: A Novel Approach

小鼠体外循环模型: 一种新方法

As prolonged cardiopulmonary bypass becomes more essential during cardiac interventions, an increasing clinical demand arises for procedure optimization ...

Microscopy Based Methods for the Assessment of Epithelial Cell Migration During In Vitro Wound Healing

Microscopy Based Methods for the Assessment of Epithelial Cell Migration During  In Vitro Wound Healing

以显微镜为基础的方法评估上皮细胞迁移过程中的体外创面愈合

Cell migration is a mandatory aspect for wound healing. Creating artificial wounds on research animal models often results in costly and complicated ...

The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation

围产儿窒息羔羊模型: 新生儿复苏模型的建立

Birth asphyxia accounts for nearly one million deaths worldwide each year, and is one of the primary causes of early neonatal morbidity and mortality. ...

Providing Visual Biofeedback Using Brightness Mode Ultrasound During a Golf Swing

在高尔夫挥杆期间使用亮度模式超声波提供视觉生物反馈

Using ultrasound biofeedback in conjunction with verbal cueing can increase muscle thickness more than verbal cueing alone and may augment traditional ...

Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise

核心耐力运动期间通过运动模式超声和表面肌电图获得的肌肉功能

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured ...

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

非原位灌注期间供体心脏的功能评估：来自压力-容量环和表面超声心动图的见解

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the ...

Extracorporeal Cardiopulmonary Resuscitation in Animal Model After Cardiac Arrest

Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest

Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model

Congenital heart disease (CHD) is the most prevalent congenital malformation, with about one million births impacted worldwide per year. Comprehensive ...