title: Can serial focussed echocardiographic evaluation in life support (FEEL) predict resuscitation outcome or termination of resuscitation (TOR)? A pilot study.
abstract: OBJECTIVE
  This study aimed to evaluate the correlation between serial echocardiography findings and return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) and to examine whether echocardiographic cardiac standstill duration can be used to predict ROSC.
  
  
  METHODS
  This was a prospective observational study of non-consecutive non-trauma adult patients with OHCA. Echocardiography was performed every 2 min during a pulse check for <10s throughout the resuscitation effort managed according to advanced life support treatment guidelines. Echocardiography findings were recorded as video clips.
  
  
  RESULTS
  Forty-eight patients were enrolled in the study. Serial echocardiographic cardiac standstill duration in the ROSC and no ROSC groups were 2.86 ± 2.07 min versus 20.30 ± 8.42 min, respectively (p<0.001). Cardiac standstill duration ≥10 min predicted non-ROSC with a sensitivity of 90.0%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 93.3%. A receiver operating characteristic curve was generated to determine the accuracy of serial echocardiographic cardiac standstill duration for predicting no ROSC. The area under the curve was 0.991 (p<0.000).
  
  
  CONCLUSIONS
  In all patients with serial echocardiographic cardiac standstill ≥10 min, no patients had ROSC. These results displayed compelling test performance and discrimination ability for subjects with and without ROSC. Our study is suggestive, and it warrants further study.
authors.affiliation: Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
authors.forename: Han Bit
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Suh
authors.affiliation: Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea. Electronic address: emer0717@nate.com.
authors.forename: Young Soon
authors.initials: YS
authors.lastname: Cho
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging* / Q000628:therapy*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D028761:Withholding Treatment
keywords: Cardiopulmonary resuscitation; Echocardiography; Life support; Out-of-hospital cardiac arrest; Ultrasound