title: Echocardiography for prognostication during the resuscitation of intensive care unit patients with non-shockable rhythm cardiac arrest.
abstract: OBJECTIVE
  Transthoracic echocardiography (TTE) during cardiopulmonary arrest (CPA) has been studied in victims of cardiac arrests. Our objective was to evaluate the feasibility and usefulness of TTE in victims of cardiac arrest with non-shockable rhythms hospitalized in intensive care units (ICUs).
  
  
  METHODS
  This prospective and observational cohort study evaluated ICU patients with CPA in asystole or pulseless electrical activity (PEA). Intensivists performed TTE during intervals of up to 10s as established in the treatment protocol. Myocardial contractility was defined as intrinsic movement of the myocardium coordinated with cardiac valve movement. PEA without contractility was classified as electromechanical dissociation (EMD), and with contractility as pseudo-EMD. The images, the rates of return of spontaneous circulation (ROSC) and the survival upon hospital discharge and after 180 days were evaluated.
  
  
  RESULTS
  A total of 49 patients were included. Image quality was considered adequate in all cases and contributed to the diagnosis of CPA in 51.0% of the patients. Of the 49 patients included, 17 (34.7%) were in asystole and 32 (65.3%) in PEA, among which 5 (10.2%) were in EMD and 27 (55.1%) in pseudo-EMD. The rates of ROSC were 70.4% for those in pseudo-EMD, 20.0% for those in EMD, and 23.5% for those in asystole. Survival upon hospital discharge and after 180 days occurred only in patients in pseudo-EMD (22.2% and 14.8%, respectively).
  
  
  CONCLUSIONS
  TTE conducted during cardiopulmonary resuscitation in ICU patients can be performed without interfering with care protocols and can contribute to the differential diagnosis of CPA and to the identification of a subgroup of patients with better prognosis.
authors.affiliation: Hospital Alemão Oswaldo Cruz - Institute of Health Education and Research, São Paulo, SP, Brazil; Irmandade da Santa Casa de Misericórdia de São Paulo - ISCMSP, São Paulo, SP, Brazil. Electronic address: uriflato@gmail.com.
authors.forename: Uri Adrian Prync
authors.initials: UA
authors.lastname: Flato
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo), São Paulo, SP, Brazil.
authors.forename: Edison Ferreira
authors.initials: EF
authors.lastname: Paiva
authors.affiliation: Hospital Alemão Oswaldo Cruz - Institute of Health Education and Research, São Paulo, SP, Brazil.
authors.forename: Mariana Teixeira
authors.initials: MT
authors.lastname: Carballo
authors.affiliation: Hospital Alemão Oswaldo Cruz - Institute of Health Education and Research, São Paulo, SP, Brazil.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Buehler
authors.affiliation: Irmandade da Santa Casa de Misericórdia de São Paulo - ISCMSP, São Paulo, SP, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marco
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Ari
authors.initials: A
authors.lastname: Timerman
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D001938:Brazil / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends
keywords: Cardiopulmonary arrest; Echocardiography; Intensive care; Prognosis