The use of ultrasound for diagnosing and guiding successful transcutaneous electrostimulation in pseudo pulseless electrical activity in a prehospital emergency setting: a case study

There are limited methods of differentiating between pulseless electrical activity (PEA) and pseudo-PEA in both prehospital and early hospital settings. According to the European Resuscitation Council (ERC) guidelines, point-of-care ultrasound (POCUS) is a rapid and effective method for differentiating between PEA and pseudo PEA. In addition, ERC guidelines recommend the use of POCUS in cases of non-shockable rhythms for the diagnosis of potentially reversible causes of sudden cardiac arrest (SCA). Here, we present the case of a 73-year-old patient who experienced sudden cardiac death due to an unshockable rhythm. Since the carotid pulse was not palpable, the patient was initially diagnosed with PEA and treated accordingly. Using POCUS during cardiopulmonary resuscitation (CPR) enabled the paramedics to diagnose pseudo-PEA in the prehospital setting. Based on ultrasound findings, successful transcutaneous pacing was applied, and POCUS monitored the treatment's effectiveness by showing color Doppler flow in the femoral artery and systolic left ventricular function. Using POCUS for post-resuscitation assessment allowed for the suspicion of myocardial infarction. This, in turn, led to the early implementation of anticoagulant and antiplatelet therapy in the ambulance. The use of POCUS during and post-CPR in the prehospital setting was crucial for altering the patient's treatment and potentially improving the outcome.