Bedside Focused Echocardiography as Predictor of Survival in Cardiac Arrest Patients: A Systematic Review

Abstract

Echocardiography performed during cardiac arrest that demonstrates an absence of cardiac activity harbors a significantly lower (but not zero) likelihood that a patient will experience ROSC. In selected patients with a higher likelihood of survival from cardiac arrest at presentation, based on established predictors of survival, echo should not be the sole basis for the decision to cease resuscitative efforts. Echo should continue to be used only as an adjunct to clinical assessment in predicting the outcome of resuscitation for cardiac arrest.

Improving Survival From Cardiac Arrest: A Review of Contemporary Practice and Challenges

“…66 A subxiphoid or subcostal, echocardiographic, 4-chamber cardiac view can be rapidly obtained from the abdomen during CPR pulse checks to guide resuscitation. [70][71][72] Identification of electromechanical dissociation (cardiac standstill) during treatment of pulseless electrical activity indicates irreversible myocardial dysfunction with such a low likelihood for achieving return of spontaneous circulation that termination of resuscitation may be considered. 70,73 Cardiac contraction (pseudo-pulseless electrical activity) portends a better prognosis for successful resuscitation.…”

“…[70][71][72] Identification of electromechanical dissociation (cardiac standstill) during treatment of pulseless electrical activity indicates irreversible myocardial dysfunction with such a low likelihood for achieving return of spontaneous circulation that termination of resuscitation may be considered. 70,73 Cardiac contraction (pseudo-pulseless electrical activity) portends a better prognosis for successful resuscitation. 70,73,74 An echocardiographic differential diagnosis can be quickly generated according to the relative sizes of the cardiac chambers and the presence or absence of a large pericardial effusion.…”

Fokussierte Notfallechokardiographie

“…Der Nachweis einer myokardialen Aktivität/Kontraktilität bei pulsloser elektrischer Aktivität gilt als positiver Prädiktor für ROSC ("return of spontaneous circulation"; [14]). In den Reanimationsleitlinien von 2010 wird die Suche nach reversiblen Ursachen eines Herz-KreislaufStillstands gefordert [15].…”

Use of Point-of-Care Ultrasonography in Simulation-Based Advanced Cardiac Life Support Scenarios

“…Ultrasonography during PEA arrest can differentiate underlying abnormalities, such as ventricular failure, pulmonary embolism, hypovolemia, and cardiac tamponade (5)(6)(7)(8)(9)(10), and may alter management of critically ill patients in up to 78% of cases (10). Additionally, ultrasonography provides prognostic information, as in cardiac standstill, which is associated with almost no likelihood of return of spontaneous circulation (11)(12)(13)(14)(15).…”