Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest
Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.
Gaspari et al. Resuscitation 109 (2016) 33-39.
To determine whether cardiac activity on US during ACLS was associated with improved survival.
A multicenter, non-randomized, prospective, protocol-driven observational study of patients presenting with out-of-hospital or in-ED arrests with a rhythm of PEA or asystole. Patients meeting criteria had an ultrasound performed at the beginning and end of ACLS. Enrolled patients were followed for a primary outcome of survival to hospital admission and secondary outcomes of ROSC and survival to hospital discharge.
Of the 793 enrolled patients, cardiac activity on ECHO was the variable most strongly associated with the three outcomes mentioned above. For ROSC, survival to admission and survival to discharge, presence of cardiac activity was associated with a survival percentage of 51.0%, 28.9%, and 3.8% respectively in comparison with 14.3%, 7.2%, and 0.6% respectively if no cardiac activity was present. Survival percentage was even higher in the patient groups that had a pericardial effusion or evidence of PE present and were treated with pericardiocentesis and thrombolysis respectively.
Presence or absence of cardiac activity on US provides useful prognostic information and may be useful in determining when resuscitative efforts can be terminated in patients presenting with PEA or asystolic arrest. US can also be useful in identifying possible lifesaving interventions outside the scope of bread and butter ACLS algorithms.