title: Cardiac movement identified on prehospital echocardiography predicts outcome in cardiac arrest patients.
abstract: BACKGROUND
  The prognostic value of emergency echocardiography (EE) in the management of cardiac arrest patients has previously been studied in an in-hospital setting. These studies mainly included patients who underwent cardiopulmonary resuscitation (CPR) by emergency medicine technicians at the scene and who arrived at the emergency department (ED) still in a state of cardiac arrest. In most European countries, cardiac arrest patients are normally treated by physician-staffed emergency medical services (EMS) teams on scene. Transportation to the ED while undergoing CPR is uncommon.
  
  
  OBJECTIVE
  To evaluate the ability of EE to predict outcome in cardiac arrest patients when it is performed by ultrasound-inexperienced emergency physicians on scene.
  
  
  METHODS
  We performed a prospective, observational study of nonconsecutive, nontrauma, adult cardiac arrest patients who were treated by physician-staffed urban EMS teams on scene. Participating emergency physicians (EPs) received a two-hour course in EE during CPR. After initial procedures were accomplished, EE was performed during a rhythm and pulse check. A single subxiphoid, four-chamber view was required for study enrollment. We defined sonographic evidence of cardiac kinetic activity as any detected motion of the myocardium, ranging from visible ventricular fibrillation to coordinated ventricular contractions. The CPR had to be continued for at least 15 minutes after the initial echocardiography. No clinical decisions were made based on the results of EE.
  
  
  RESULTS
  Forty-two patients were enrolled in the study. The heart could be visualized successfully in all patients. Five (11.9%) patients survived to hospital admission. Of the 32 patients who had cardiac standstill on initial EE, only one (3.1%) survived to hospital admission, whereas four out of 10 (40%) patients with cardiac movement on initial EE survived to hospital admission (p = 0.008). Neither asystole on initial electrocardiogram nor peak capnography value, age, bystander CPR, or downtime was a significant predictor of survival. Only cardiac movement was associated with survival, and cardiac standstill at any time during CPR resulted in a positive predictive value of 97.1% for death at the scene.
  
  
  CONCLUSIONS
  Our results support the idea of focused echocardiography as an additional criterion in the evaluation of outcome in CPR patients and demonstrate its feasibility in the prehospital setting.
authors.affiliation: Austrian Red Cross, Medizinercorps Graz, Austria. g.aichinger@gmail.com
authors.forename: Gernot
authors.initials: G
authors.lastname: Aichinger
authors.forename: Peter Michael
authors.initials: PM
authors.lastname: Zechner
authors.forename: Gerhard
authors.initials: G
authors.lastname: Prause
authors.forename: Florian
authors.initials: F
authors.lastname: Sacherer
authors.forename: Gernot
authors.initials: G
authors.lastname: Wildner
authors.forename: Craig L
authors.initials: CL
authors.lastname: Anderson
authors.forename: Mirjam
authors.initials: M
authors.lastname: Pocivalnik
authors.forename: Ulrike
authors.initials: U
authors.lastname: Wiesspeiner
authors.forename: John Christian
authors.initials: JC
authors.lastname: Fox
mesh_terms: D000368:Aged; D001317:Austria; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000000981:diagnostic imaging* / Q000401:mortality