The paper: Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest, was published in Resuscitation (http://dx.doi.org.ezproxy.library.dal.ca/10.1016/j.resuscitation.2016.09.018) reported that “Cardiac activity on ultrasound was the variable most associated with survival following cardiac arrest. Ultrasound during cardiac arrest identifies interventions outside of the standard ACLS algorithm.”
Abstract
Background
Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival.
Methods
We conducted a non-randomized, prospective, protocol-driven observational study at 20 hospitals across United States and Canada. Patients presenting with out-of-hospital arrest or in-ED arrest with pulseless electrical activity or asystole were included. An ultrasound was performed at the beginning and end of ACLS. The primary outcome was survival to hospital admission. Secondary outcomes included survival to hospital discharge and return of spontaneous circulation.
Findings
793 patients were enrolled, 208 (26.2%) survived the initial resuscitation, 114 (14.4%) survived to hospital admission, and 13 (1.6%) survived to hospital discharge. Cardiac activity on US was the variable most associated with survival at all time points. On multivariate regression modeling, cardiac activity was associated with increased survival to hospital admission (OR 3.6, 2.2–5.9) and hospital discharge (OR 5.7, 1.5–21.9). No cardiac activity on US was associated with non-survival, but 0.6% (95% CI 0.3–2.3) survived to discharge. Ultrasound identified findings that responded to non-ACLS interventions. Patients with pericardial effusion and pericardiocentesis demonstrated higher survival rates (15.4%) compared to all others (1.3%).
Conclusion
Cardiac activity on ultrasound was the variable most associated with survival following cardiac arrest. Ultrasound during cardiac arrest identifies interventions outside of the standard ACLS algorithm.
A very good critique of this paper has been published on the well-known EM Blog – St. Emlyns – JC: Is this the REASON to use USS in cardiac arrest? St.Emlyn’s
St. Emlyn’s Bottom Line: A lack of cardiac activity on initial USS is very probably associated with a worse prognosis. The role of USS in improving outcome as an intervention in cardiac arrest is less certain
We will be asking our Research Director (Dr Paul Atkinson), who was closely involved in this study, for his take on the results and how they should be interpreted/incorporated into practice. This has been posted here.
