Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators

Abstract

Introduction This third study in the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) series examined potential relationships between point-of-care ultrasound (PoCUS) use and the length of resuscitation, the frequency of interventions, and clinical outcomes during cardiac arrest. Methods A health records review was completed for adult patients (>19 years, without a do not resuscitate (DNR) order) who presented to a tertiary emergency department in cardiac arrest between 2010 and 2014. Patients were grouped based on PoCUS use and findings for cardiac activity. Data were analyzed for length of resuscitation, frequency of interventions, return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD). Results Of the 223 patients who met inclusion criteria, 180 (80.7%) received assessment by PoCUS during cardiac arrest management in the emergency department (ED). In the PoCUS group, 21 (11.6%) demonstrated cardiac activity and 159 (88.4%) did not. Patients with activity on PoCUS had longer mean resuscitation times (27.3; 95% confidence interval 17.7-37.0 min) than patients with no activity (11.51; 10.2-12.8 min) and patients who did not receive a PoCUS exam (14.36; 9.89-18.8 min). Patients with cardiac activity on PoCUS were more likely to receive endotracheal intubation (ET; 95.23%; 86.13-104.35%) and epinephrine (Epi; 100%; 100-100%) than patients with no activity (ET: 46.54%; 38.8-54.3%; Epi: 82.39%; 76.50-88.31%) and those with no PoCUS (ET: 65.11%; 50.87-79.36%; Epi: 81.39%; 69.76-93.03%). Those with no cardiac activity on PoCUS were much less likely to achieve ROSC (19.5%; 13.4-25.6), SHA (6.9%; 2.97-10.86%) and SHD (0.6%; -0.5-1.8%) compared to those with cardiac activity on PoCUS (ROSC; 76.19%; 57.97-94.4%), SHA (33.3%; 13.2-53.5%), SHD (9.5%; -3-22.07%), and those with no PoCUS (ROSC 39.5%; 24.9-54.1%; SHA 27.9%; 14.5- 41.3%, and SHD 6.9%; -0.6-14.59). Conclusions Emergency department cardiac arrest patients with cardiac activity on PoCUS received longer resuscitation with higher rates of intervention as compared to those with negative findings or when no PoCUS was performed. Patients with cardiac activity on PoCUS had improved clinical outcomes as compared with patients not receiving PoCUS, and patients with no activity on PoCUS.

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

“…The SysRev identified no RCTs and 15 relevant observational studies. 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 The overall certainty of evidence was rated as very low for all outcomes primarily due to risk of bias, inconsistency, and/or imprecision. There was a substantial risk of bias due to prognostic factor measurement, outcome measurement, adjustment for prognostic factors, or confounding.…”

Novel 4W (When-Where-What-What) Approach of Training Point-of-Care Ultrasound (POCUS) Application in Resuscitation With High-Fidelity Simulator

“…This approach is necessary for preparing residents for the real-life scenarios they will encounter in practice. This is poignantly illustrated by recent research suggesting that evaluating critical cardiopulmonary scenarios with POCUS is an important step in developing properly tailored resuscitation plans [6,7]. Moreover, when POCUS is incorporated into ACLS and detects cardiac activity, significant improvements in return of spontaneous circulation and hospital survivorship have been observed [6,7].…”

“…Point-of-care ultrasound (POCUS) has been successfully used in clinical settings for this purpose [2][3][4][5]. POCUS's implications in acute cardiopulmonary failure are uniquely advantageous by offering quick evaluations without resuscitation interference [6][7][8]. Similarly, this modality has established new utility amidst the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic for the evaluation of cardiopulmonary pathology in presumed or confirmed patients [9].…”

I Will Be at Your (Bed)Side – The Role of Bedside Echocardiography for Non-Cardiologists

“…The impact of the use of bedside echocardiography has been extensively studied in the emergency/critical care context where it has been demonstrated to increase diagnostic accuracy and reduce the time to diagnosis in the management of cardiac arrest, cardiac trauma, shock and dyspnea [3,4]. Moreover, many studies have shown good diagnostic accuracy of miniaturized devices in the hands of different specialists and in different settings using standard echocardiography as a reference standard [5][6][7].…”

“…LV hypertrophy is usually better assessed from a PLAX view by the recognition of increased wall thickness. [3,4]. Darüber hinaus haben viele Studien eine gute diagnostische Genauigkeit von miniaturisierten Geräten in den Händen verschiedener Spezialisten und in verschiedenen Bereichen unter Verwendung der Standard-Echokardiografie als Referenzstandard gezeigt [5][6][7].…”