Background: The Royal College of Radiologists guidelines (2005) and College of Emergency Medicine guidelines (2007) support focussed ultrasound by emergency physicians as a useful adjunct in arrest and peri-arrest situations to identify pulseless electrical activity and pericardial effusion/tamponade. We introduced routine bedside focussed cardiac ultrasound in patients presenting with cardiac arrest when a physician experienced in ultrasound scanning was present. We performed a prospective service evaluation to: (1) assess the ability to integrate focussed cardiac scan into current advanced life support guidelines; (2) evaluate detection of ventricular wall motion and pericardial effusion and compare with outcome; (3) evaluate if scan led to any intervention.

Methods: We prospectively collected data regarding the type of arrest, ability to scan during the 10 s rhythm check, incidence of
pericardial effusion and ventricular wall motion, interventionsperformed, return of spontaneous circulation (ROSC) and survival to emergency department (ED) discharge.

Results
51 patients had cardiac ultrasound during cardiac arrest. 48 (93%) scans were adequate and 45 (88%) were obtained within a 10 sec pulse check. 20 patients (39%) had ventricular wall motion, of which 1 (2%) survived to hospital discharge. 3 (7%) had a pericardial effusion. Six patients (12%) had an intervention performed beyond ALS management as a result of the US. These included pericardiocentesis, inotropes, thrombolysis and chest drains.

Conclusions.
We conclude that cardiac ultrasound is possible during cardiac arrest and the scan findings may direct life saving interventions. There is as yet insufficient evidence to stop CPR based on cardiac ultrasound alone.