UMEM Educational Pearls

Title: POCUS in Prognostication of Non-Shockable, Atraumatic Cardiac Arrest

Category: Critical Care

Keywords: Resuscitation, cardiac arrest, POCUS, ultrasound, ROSC (PubMed Search)

Posted: 4/9/2019 by Kami Windsor, MD
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Background:  Previous systematic reviews1,2,3 have indicated that the absence of cardiac activity on point-of-care ultrasound (POCUS) during cardiac arrest confers a low likelihood of return of spontaneous circulation (ROSC), but included heterogenous populations (both traumatic and atraumatic cardiac arrest, shockable and nonshockable rhythms).

The SHoC investigators4 are the first to publish their review of nontraumatic cardiac arrests with nonshockable rhythms, evaluating POCUS as predictor of ROSC, survival to admission (SHA), and survival to discharge (SHD) in cardiac arrests occurring out-of-hospital or in the ED.

  • 10 studies, 1485 patients
  • Compared to absence of cardiac activity, presence of cardiac activity = higher odds, increased incidence of ROSC, SHA, and SHD
  • Pooled sensitivity for ROSC, SHA, SHD relatively low (60%, 75%, 69%, respectively)
    • On subgroup analysis, sensitivity higher in PEA group (77%) than asystole group (25%)

 

Bottom Line:  In nontraumatic cardiac arrest with non-shockable rhythms, the absence of cardiac activity on POCUS may not, on its own, be as strong an indicator of poor outcome as previously thought.

 

References

  1. Blyth L, Atkinson P, Gadd K, Lang E. Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Acad Emerg Med. 2012;19(10):1119-26.
  2. Tsou PY, Kurbedin J, Chen YS, et al. Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis. Resuscitation. 2017; 114:92-9.
  3. Wu C, Zheng Z, Jiang L, et al. The predictive value of bedside ultrasound to restore spontaneous circulation in patients with pulseless electrical activity: A systematic review and meta-analysis. PLoS One. 2018;13(1):e0191636.
  4. Lalande E, Burwash-Brennan T, Burns K, et al. Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHoC Investigators. Resuscitation. 2019; https://doi.org/10.1016/j.resuscitation.2019.03.027.