None listed
Conditions
Brief summary
Current cardiac arrest algorithms require assessment of the return of spontaneous circulation (ROSC) following rhythm checks. Current recommendations for assessment of ROSC include observation for patient movement or spontaneous respiration, both of which may be absent in sedated and paralysed patients. Healthcare professionals are advised to check the pulse in the presence of an organized rhythm, however previous studies have shown poor ability to correctly detect the presence or absence of a pulse in a simulated pulseless electrical activity (PEA) arrest. In one study, 45% of participants incorrectly diagnosed pulselessness in cardiac surgery patients no longer on bypass, despite systolic pressures greater than 80mmHg. In coronary artery bypass graft (CABG) surgery, when coming off bypass, blood flow changes from continuous to pulsatile. This may offer a model by which to simulate the return of pulsatile flow, and allow a comparison of radial arterial pressures when pulsatile flow becomes first apparent on 2D US and colour flow Doppler US of the carotid artery. This pilot study proposes to investigate whether pulsatile flow can be reliably assessed by the use of carotid artery ultrasound, and whether CABG patients can be used as a model to evaluate this.
Interventions
This is an interventional trial with two arms. The trial will evaluate the use of US to detect pulsatile flow compared to the blood pressure as measured on the radial arterial line. The participants will be randomised to 2D US or colour-Doppler. One of the investigators will ultrasound the carotid artery of patients as they come off bypass and a video of the image recorded. At the same time a video will be recorded of the anaesthetic monintor. Three Independent investigators will assess the ultr
This is an interventional trial with two arms. The trial will evaluate the use of US to detect pulsatile flow compared to the blood pressure as measured on the radial arterial line. The participants will be randomised to 2D US or colour-Doppler. One of the investigators will ultrasound the carotid artery of patients as they come off bypass and a video of the image recorded. At the same time a video will be recorded of the anaesthetic monintor. Three Independent investigators will assess the ultrasound images and will record the time at which they think sustained pulsatile flow occurs, This will then be correlated to the blood presssure of the participants. Those assessing the ultrasound images will not have access to the monitor videos. The assessors will be three anaesthetists (two cardiac and one general anaesthetist). Videos will be recorded as rewarming of the heart begins and continue for approximately 5 minutes after the return of spontaneous circulation
Sponsors
St George Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Age > 18. Ability to offer informed consent. Undergoing cardiac surgery requiring cardiac bypass from the perfusion machine.
Exclusion criteria
Previous surgery involving the great blood vessels including aorta or carotid arteries. Patients in whom the cardiac surgeon considers enrolment will be inappropriate due to high surgical risk, patients with intraaortic balloon pump, known peripheral vascular disease.
Outcome results
None listed