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

Lalande, Élizabeth; Burwash-Brennan, Talia; Burns, Katharine M.; Atkinson, Paul; Lambert, Michael J.; Jarman, B; Lamprecht, Hein; Banerjee, Anirban; Woo, Michael Y.; Connolly, James A.; Hoffmann, Beatrice; Nelson, Bret P.; Noble, Vicki E.

doi:10.1016/j.resuscitation.2019.03.027

Cited by 43 publications

(18 citation statements)

References 21 publications

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“…Concerning the patient group with PEA, this work is in line with previous studies 3, 13 that point to an ultrasound assessment for cardiac arrest patients with PEA, since presence of electrical activity (i.e., pPEA) could indicate higher probabilities of ROSC or even survival for the patient. Our study showed an important difference at survival level between patients with pPEA and PEA -33.3 % vs. 0 %.…”

Section: Discussionsupporting

confidence: 88%

Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

Devia

Navarrete

Ortiz

2020

Preprint

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Background: The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. Objective: This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients, and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. Materials and Methods: This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor, Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. Results: Of a total of 108 patients the median of the age was 71 years, 65.8% were male subjects, the most frequent cause for cardiac arrest was the cardiogenic shock(32.4%). ROSC was observed in 41 cases(37.9%) and survival at discharge was 18 cases(16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. Conclusion: There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

show abstract

Section: Discussionsupporting

confidence: 88%

Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

Devia

Navarrete

Ortiz

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Concerning the patient group with PEA, this work is in line with previous studies [3,13] that point to an ultrasound assessment for cardiac arrest patients with PEA, since the presence of electrical activity (i.e., pPEA) could indicate higher probabilities of ROSC or even survival for the patient. Our study showed an important difference at survival level between patients with pPEA and PEA-33.3% vs. 0%.…”

Section: Discussionsupporting

confidence: 88%

Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

2020

View full text Add to dashboard Cite

Background The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. Objective This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. Materials and methods This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. Results Of a total of 108 patients, the median of the age was 71 years, 65.8% were male subjects, and the most frequent cause for cardiac arrest was the cardiogenic shock (32.4%). ROSC was observed in 41 cases (37.9%) and survival at discharge was 18 cases (16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. Conclusion There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

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“…In patients with a low prior probability of ROSC, the absence of spontaneous cardiac movements on echocardiography can predict a low chance of survival and guide the decision to end resuscitation. Another systematic review and meta-analysis of 10 studies with 1486 patients confirmed that cardiac activity in POCUS-CA was associated with better probabilities of ROSC and survival at discharge, in non-traumatic cardiac arrest, and with non-defibrillable rhythm [ 60 ]. The overall conclusion of the evidence is that the evaluation of cardiac motion on transthoracic echocardiography is a valuable tool in predicting short-term cardiac resuscitation outcomes.…”

Section: Practical Approach Use Of the Pocusmentioning

confidence: 99%

Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article

et al. 2021

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The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcome.

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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

Cited by 43 publications

References 21 publications

Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article

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