FEELing for a Pulse and Shocking Asystole

This podcast is based on the Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients (FEEL) Study, and inferences made from it.

The study was to determine the feasibility of prehospital ultrasound, but there were more astonishing results:

  • 74.5% of patients in (pseudo) PEA had cardiac activity.
  • 35% of patients in (suspected) asystole had cardiac activity.

We brought on EMS Physician Walt Lubbers to answer whether or not ultrasound would inform our decision making or alter how we manage a patient in cardiac arrest.  

What we really wanted to know is 1) should we shock asystole “just in case” it could be very fine VF, and 2) would the presence of cardiac activity on ultrasound change how we manage a patient in PEA.

We discussed in detail some cardiac arrest physiology and referenced a video lecture and studies cited by Dr. Peter Kudenchuk from the Resuscitation Academy.

Now listen to the podcast:


  • Breitkreutz, R., Price, S., Steiger, H. V., Seeger, F. H., Ilper, H., Ackermann, H., … Walcher, F. (2010). Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: A prospective trial. Resuscitation. https://doi.org/10.1016/j.resuscitation.2010.07.013
  • Breitkreutz, R., Walcher, F., & Seeger, F. H. (2007). Focused echocardiographic evaluation in resuscitation management: Concept of an advanced life support-conformed algorithm. Critical Care Medicine. https://doi.org/10.1097/01.CCM.0000260626.23848.FC
  • Clattenburg, E. J., Wroe, P., Brown, S., Gardner, K., Losonczy, L., Singh, A., & Nagdev, A. (2018). Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: A prospective cohort study. Resuscitation. https://doi.org/10.1016/j.resuscitation.2017.11.056
  • Dick, W. F., Eberle, B., Wisser, G., & Schneider, T. (2000). The carotid pulse check revisited: what if there is no pulse? Crit Care Med. https://doi.org/10.1097/00003246-200011001-00002
  • Huis in ’t Veld, M. A., Allison, M. G., Bostick, D. S., Fisher, K. R., Goloubeva, O. G., Witting, M. D., & Winters, M. E. (2017). Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation. https://doi.org/10.1016/j.resuscitation.2017.07.021

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