Does upper torso cyanosis give an indication of the aetiology of cardiac arrest?
Date First Published:
March 24, 2025
Last Updated:
April 22, 2025
Report by:
Brad Gander, Critical Care Paramedic (South East Coast Ambulance Service)
Search checked by:
Lewis Smart, South East Coast Ambulance Service
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.
(('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.
Outcome:
MEDLINE: 78 results
CINAHL: 11 results
CINAHL: 11 results
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Incidence and Significance of Upper Body Cyanosis in Nontraumatic Cardiac Arrest Benjamin D. Swoboda, Mickey S. Eisenberg, Richard Harruff & Corinne L. Fligner 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:
- Benjamin D. Swoboda, Mickey S. Eisenberg, Richard Harruff & Corinne L. Fligner. Incidence and Significance of Upper Body Cyanosis in Nontraumatic Cardiac Arrest