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Resuscitation. 2016 Dec;109:33-39. doi: 10.1016/j.resuscitation.2016.09.018. Epub 2016 Sep 28.

Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.

Author information

1
University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: Romolo.Gaspari@umassmemorial.org.
2
Carolinas Medical Center, Charlotte, NC, United States.
3
University of Arizona, Tucson, AZ, United States.
4
Massachusetts General Hospital, Boston, MA, United States.
5
Christiana Care Health System, Newark, DE, United States.
6
Washington University School of Medicine, St. Louis, MO, United States.
7
University of Ottawa, Ottawa, ON, Canada.
8
Dalhousie University, Saint John, NB, Canada.
9
University of Massachusetts Medical School, Worcester, MA, United States.
10
Intermountain Medical Center and University of Utah, Salt Lake City, UT, United States.
11
LSU Health Sciences Center, Baton Rouge, LA, United States.
12
North Shore University Hospital, Manhasset, NY, United States.
13
Advocate Christ Medical Center, Chicago, IL, United States.
14
Brown University, Providence, RI, United States.
15
Duke University School of Medicine, Durham, NC, United States.
16
Brigham and Women's Hospital, Boston, MA, United States.
17
Indiana University, Indianapolis, IN, United States.
18
Yale University School of Medicine, New Haven, CT, United States.
19
NYU Bellevue Hospital, New York, NY, United States.
20
Kingston General Hospital, Kingston, ON, Canada.
21
Castle Hospital, Kailua, HI, United States.

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.

KEYWORDS:

Cardiac arrest; Resuscitation; Ultrasound

[Indexed for MEDLINE]

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