Role of initial cardiac activity assessed by point-of-care ultrasonography in predicting cardiac arrest outcomes: A prospective cohort study
1Department of Emergency Medicine, The Mission Hospital, Durgapur, West Bengal, India
2Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
Keywords: Cardiac activity, cardiac arrest, emergency medicine, point‑of‑care ultrasound, return of spontaneous circulation, survival
OBJECTIVES: This study was conducted to investigate the association between visible cardiac activity in point-of-care ultrasound (POCUS) and outcomes of cardiac arrest such as the return of spontaneous circulation (ROSC), survival to inpatient admission (SIA), and survival to hospital discharge (STHD).
METHODS: This was a single center, prospective cohort study conducted in the emergency department (ED). Adult (age >18 years) patients in cardiac arrest were included in the study. Exclusion criteria of the study were – traumatic arrest, out of hospital cardiac arrest resuscitated before ED admission, and patients presenting with initial shockable rhythm. Patients whose ultrasound images could not be obtained and whose resuscitation stopped following POCUS were also excluded from the study. POCUS examination was done after 2 min of initiation of cardiopulmonary resuscitation (CPR) and visible cardiac activity was defined as any visible movement of the myocardium, excluding movement of blood within cardiac chambers, or isolated valve movement. The duration of POCUS examinations was limited to 10 s. The association of initial cardiac activity in POCUS with the outcomes of cardiac arrest was investigated.
RESULTS: Out of 140 patients screened, 84 patients were included in the study. Rates of ROSC, SIA, and STHD were found in 23 (27.4%), 9 (10.7%), and 2 (2.4%) patients, respectively. Only 15 out of 84 (17.9%) patients had cardiac activity on the initial POCUS examination. Cardiac activity was seen in 52.2% of patients with ROSC, which was significantly higher (P < 0.001) as compared with the no ROSC group (4.9%). Unlike the above association, there was no difference in the incidence of initial cardiac activity in patient groups who got admitted (SIA) and discharged (STHD) versus those who died. In the multivariate regression analysis, the duration of CPR and initial cardiac activity significantly predicted the rate of ROSC, with an adjusted odds ratio of 0.93 (95% confidence interval [CI]: 0.86–0.99, P = 0.04) and 24.8 (95% CI: 3.17–89.41, P = 0.002), respectively. None of the variables predicted SIA and STHD. The positive likelihood ratio of cardiac activity for predicting ROSC, SIA, and STHD were 10.6, 2.1, and 2.9, respectively.
CONCLUSION: Integration of POCUS in cardiac arrest resuscitation was shown to be helpful in terms of prognostic significance of the presence of initial cardiac activity in terms of ROSC.
* That both the first authors have equal contributions to this original work.
How to cite this article: Thandar S, Sahu AK, Sinha TP, Bhoi S. Role of initial cardiac activity assessed by point-of-care ultrasonography in predicting cardiac arrest outcomes: A prospective cohort study. Turk J Emerg Med 2023;23:24-9.
• Name of the board: Institute Ethics Committee, All India Institute of Medical Sciences, New Delhi, India
• Approval number: IECPG‑609/08.12.2016
• Approval Date: 16/02/2017
• Again revised on: 19/06/2022.
Consent was taken after the end of resuscitative efforts as waiver of informed consent from legally accepted representative of the patient.
• Dr. Soumitra – conceptualization, methodology, data curation, writing – original draft, supervision
• Dr.Ankit – writing – original draft, statistical analysis, visualization, methodology, revision
• Dr. Sanjeev – conceptualization, investigation, resources, data curation, writing – review and editing, supervision
• Dr. Tej – conceptualization, data curation, writing – review and editing, supervision.