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Resuscitation. 2019 Apr 9;139:159-166. doi: 10.1016/j.resuscitation.2019.03.027. [Epub ahead of print]

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.

Author information

1
Department of Emergency Medicine, Université Laval, Centre Hospitalier de l'Université Laval (CHUL), CHU de Québec, Québec, Canada. Electronic address: elizabeth.lalande.1@ulaval.ca.
2
Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Canada. Electronic address: tburwash@toh.ca.
3
Department of Emergency Medicine, Advocate Christ Medical Center, USA. Electronic address: katharine.m.burns@gmail.com.
4
Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Canada. Electronic address: Paul.Atkinson@dal.ca.
5
Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL United States. Electronic address: mlambert62@mac.com.
6
Royal Victoria Infirmary, Newcastle upon Tyne, UK; Teesside, Middlesbrough, United Kingdom. Electronic address: bob.jarman@mac.com.
7
Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa. Electronic address: hl@sun.ac.za.
8
Department of Emergency Medicine, Horizon Health Network, Saint John Regional Hospital, Saint John, NB, Canada. Electronic address: dr.ankona.banerjee@ws-ts.nb.ca.
9
Department of Emergency Medicine, University of Ottawa, Ottawa Hospital Research Institute, Canada. Electronic address: mwoo@toh.ca.

Abstract

AIMS:

To evaluate the accuracy of PoCUS in predicting return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) in adult non-traumatic, non-shockable out-of-hospital or emergency department cardiac arrest.

METHODS:

Medline, EMBASE, Cochrane, CINAHL, ClinicalTrials.gov and the World Health Organization Registry were searched for eligible studies. Data analysis was completed according to PRISMA guidelines. A random-effects meta-analysis model was used with I-squared statistics for heterogeneity.

RESULTS:

Ten studies (1486 participants) were included. Cardiac activity on PoCUS had a pooled sensitivity of 60.3% (95% confidence interval 38.1%-78.9%) and specificity of 91.5%(80.8%-96.5%) for ROSC. The sensitivity of cardiac activity on PoCUS for predicting ROSC was 26.1%(7.8%-59.6%) in asystole compared with 76.7% (61.3%-87.2%) in PEA. Cardiac activity on PoCUS, compared to absence, had odd ratios of 16.90 (6.18-46.21) for ROSC, 10.30(5.32-19.98) for SHA and 8.03(3.01-21.39) for SHD. Positive likelihood ratio (LR) was 6.87(3.21-14.71) and negative LR was 0.27(0.12-0.60) for ROSC.

CONCLUSIONS:

Cardiac activity on PoCUS was associated with improved odds for ROSC, SHA, and SHD in non-traumatic, non-shockable cardiac arrest. We report a lower sensitivity and higher negative likelihood ratio, but greater heterogeneity compared to previous systematic reviews. PoCUS may provide valuable information in the management of non-traumatic PEA or asystole, but should not be viewed as the sole predictor in determining outcomes.

KEYWORDS:

Cardiac arrest; Focused echocardiography; Point-of-care ultrasound; Prognosis

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