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Three Part Question

In [adult patients in cardiac arrest] does [the presence of upper torso cyanosis] give [an indication of the aetiology?]

Clinical Scenario

You are called to attend an adult male in cardiac arrest. When commencing CPR your colleague notices pronounced cyanosis of the upper torso and queries whether this may indicate a pulmonary embolism.

Search Strategy

MEDLINE via PubMed

(('cardiac arrest'[Title/Abstract] OR arrest[Title/Abstract] OR resus*[Title/Abstract]) AND ('nipple line cyanosis'[Title/Abstract] OR 'upper body cyanosis'[Title/Abstract] OR cyanos*[Title/Abstract] OR 'upper torso cyanosis'[Title/Abstract] OR demarcation[Title/Abstract]))

English language
Adult

CINAHL

XB ( 'cardiac arrest' OR arrest OR resus* ) AND XB ( 'nipple line cyanosis' OR 'upper body cyanosis' OR cyanos* OR 'upper torse cyanosis' OR demarcation )

English language
Adult

Manual screening of reference lists of selected articles.

Search Outcome

MEDLINE: 78 results
CINAHL: 11 results

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Swoboda et al. 2000-2004 United States	Adult non-traumatic cardiac arrest patients	Incidence and Significance of Upper Body Cyanosis in Nontraumatic Cardiac Arrest	To determine the incidence and significance of upper body cyanosis in adult non-traumatic cardiac arrest	108/3526 patients had mention of nipple line cyanosis on EMS patient record 38 had autopsy data available 6/38 had haemopericardium compared to none in control group	Small numbers – 38/108 had autopsy data Retrospective patient record review 10 other causes found in remaining 32 patients albeit no significant differences with control group

References

1. Benjamin D. Swoboda, Mickey S. Eisenberg, Richard Harruff & Corinne L. Fligner Incidence and Significance of Upper Body Cyanosis in Nontraumatic Cardiac Arrest Prehospital Emergency Care 02 Jul 2009; 207-209