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• W2040962332 abstract "Survival from cardiac arrest presenting initially with asystole or pulseless electrical activity is very unlikely unless all relevant reversible causes are recognized and treated effectively.1Nolan J.P. Soar J. Zideman D.A. et al.ERC Guidelines Writing GroupEuropean Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary.Resuscitation. 2010; 81: 1219-1276Abstract Full Text Full Text PDF PubMed Scopus (1024) Google Scholar In some patients, extensive differential diagnosis is needed to ascertain the cause of cardiac arrest, especially if differentiation between cardiovascular and respiratory aetiology is necessary. Routine initial evaluation, including chest X-ray may not be sufficient to diagnose alterations in distribution of ventilation that may be present in some respiratory disorders. Although examination with chest ultrasound could assess lung and pleural cavity pathologies,2Lichtenstein D.A. Mezière G.A. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol.Chest. 2008; 134: 117-125Crossref PubMed Scopus (1120) Google Scholar this technique requires expertise and does not directly quantify regional ventilation, while the benefits of computed tomography (CT) should always be weighted to the risks and disadvantages of patient's intra-hospital transportation. Use of a non-invasive method, an electrical impedance tomography (EIT), which has already been used for assessment of lung volumes and distribution of ventilation under various clinical conditions,3Costa E.L. Lima R.G. Amato M.B. Electrical impedance tomography.Curr Opin Crit Care. 2009; 15: 18-24Crossref PubMed Scopus (119) Google Scholar, 4Blankman P. Gommers D. Lung monitoring at the bedside in mechanically ventilated patients.Curr Opin Crit Care. 2012; 18: 261-266Crossref PubMed Scopus (22) Google Scholar has not become common in post-resuscitation care. We report the case of a 61-year-old man admitted after successful resuscitation from asystolic out-of-hospital cardiac arrest (OHCA) following a short period of severe dyspnoea. His personal history included chronic obstructive pulmonary disease of unknown grading, and an already survived OHCA few years ago. On admission, there were non-specific changes on the ECG. An echocardiography showed right ventricular hypertrophy, normal left ventricular function, and no signs of massive pulmonary embolism. A left-sided pneumothorax was suspected based on a chest X-ray, but inserted chest tube released only a minimal amount of air. The patient remained haemodynamically stable and did not require catecholamines. Arterial blood gases revealed metabolic acidosis with no retention of carbon dioxide (pH 7.3, PaCO2 4.64 mmHg, BE −8.5 mmol/l, PaO2 21.6 mmHg on 40% oxygen and positive end-expiratory pressure of 6 cm H2O). Inflammatory markers were low. EIT scanning (PulmoVista 500, Dräger, Germany) was initiated and showed excessive abnormality in distribution of ventilation. The right lung was receiving 80%, while the left one only 20% of a tidal volume; normal ratio is approx. 55–45%5Darke C.S. Astin T.W. Differential ventilation in unilateral pulmonary artery occlusion.Thorax. 1972; 27: 480Crossref PubMed Scopus (5) Google Scholar (Fig. 1a) . A chest ultrasound did not reveal any signs of pleural pathology or lung consolidation, but flexible bronchoscopy proved signs of tracheobronchomalacia. These examinations suggested high probability of respiratory disorder as a primary cause of cardiac arrest. Later, a contrast enhanced CT scan confirmed initial findings: severe left lower lobe hyperinflation due to heterogeneous panlobular emphysema and no signs of pulmonary embolism (Fig. 1b). After initial treatment with corticosteroids, empiric antibiotics and bronchodilatators, the difference in distribution of ventilation diminished with final ratio 67–33% of tidal volume between both sides. The patient was successfully weaned from mechanical ventilation, and transferred to a rehabilitation facility few days later. In this patient, an EIT was used to visualize and quantify the distribution of ventilation, which helped to recognize the cause of cardiac arrest. We suggest that assessment of regional ventilation using a non-invasive bedside method may be helpful in confirmation of respiratory causes of OHCA, and prevent unnecessary or logistically complicated examinations. None." @default.
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• W2040962332 date "2014-08-01" @default.
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• W2040962332 title "Assessment of regional ventilation with the electrical impedance tomography in a patient after asphyxial cardiac arrest" @default.
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• W2040962332 doi "https://doi.org/10.1016/j.resuscitation.2014.04.028" @default.
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