RHAPSody: Diagnostic Utility of RUSH Following ROSC

This will be a prospective observational study of adult primary cardiac arrest patients
presenting to Shands Emergency Department following ROSC or actively in cardiac arrest with
subsequent ROSC after treatment in the emergency department. The study will be a single
center pilot study to evaluate the role of the extended RUSH exam in patients following
cardiac arrest in order to potentially diagnose the cause of their arrest. No control group
will be included in this study due to ethical concerns of withholding a potentially
life-saving diagnostic test. Patients will be treated with ACLS per standard of care and
resuscitation measures given. Within two hours of return of spontaneous circulation, the RUSH
exam will be performed by ultrasound-trained emergency department physicians with images
saved into the Qpath system, our already existing database where all emergency ultrasound
exams - education and diagnostic - are stored currently. The physician who performed the exam
will fill out a checklist with their interpretation and findings based on the elements
included in the exam. The data collected will be stored in a RedCap database. Identifying
data will be removed from the images and reviewed by two experienced ultrasonographers who
will give separate interpretations, and inter-observer reliability will be examined. We will
then correlate the interpretation with that of the physicians performing the exam. The
elements of the RUSH exam that will be performed include focused evaluation of the heart,
inferior vena cava, abdomen and aorta with the addition of evaluation for DVT and ocular
ultrasound. The evaluation for DVT will be an abbreviated exam with one view of each of the
bilateral femoral veins and popliteal veins. Techniques for performing the exam are based on
the 2012 RUSH guidelines [2]. The data will undergo statistical analysis to determine if the
data supported the initial hypotheses. Subjects will be contacted 30 days following the
initial study for telephone follow-up and a CPC assessment for neurologic recovery will also
be performed at that time.

Inclusion Criteria:

- Incoming ER patients with return of spontaneous circulation after cardiac arrest

Exclusion Criteria:

- Patients who do not achieve return of spontaneous circulation long enough for the exam
to be performed

- Patients who have initial cardiac arrest while on an inpatient unit of the hospital