Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.
Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival.



We conducted a non-randomized, prospective, protocol-driven observational study at 20 hospitals across United States and Canada. Patients presenting with out-of-hospital arrest or in-ED arrest with pulseless electrical activity or asystole were included. An ultrasound was performed at the beginning and end of ACLS. The primary outcome was survival to hospital admission. Secondary outcomes included survival to hospital discharge and return of spontaneous circulation.



793 patients were enrolled, 208 (26.2%) survived the initial resuscitation, 114 (14.4%) survived to hospital admission, and 13 (1.6%) survived to hospital discharge. Cardiac activity on US was the variable most associated with survival at all time points. On multivariate regression modeling, cardiac activity was associated with increased survival to hospital admission (OR 3.6, 2.2-5.9) and hospital discharge (OR 5.7, 1.5-21.9). No cardiac activity on US was associated with non-survival, but 0.6% (95% CI 0.3-2.3) survived to discharge. Ultrasound identified findings that responded to non-ACLS interventions. Patients with pericardial effusion and pericardiocentesis demonstrated higher survival rates (15.4%) compared to all others (1.3%).



Cardiac activity on ultrasound was the variable most associated with survival following cardiac arrest. Ultrasound during cardiac arrest identifies interventions outside of the standard ACLS algorithm.
University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: Romolo.Gaspari@umassmemorial.org.
Romolo
R
Gaspari
Carolinas Medical Center, Charlotte, NC, United States.
Anthony
A
Weekes
University of Arizona, Tucson, AZ, United States.
Srikar
S
Adhikari
Massachusetts General Hospital, Boston, MA, United States.
Vicki E
VE
Noble
Christiana Care Health System, Newark, DE, United States.
Jason T
JT
Nomura
Washington University School of Medicine, St. Louis, MO, United States.
Daniel
D
Theodoro
University of Ottawa, Ottawa, ON, Canada.
Michael
M
Woo
Dalhousie University, Saint John, NB, Canada.
Paul
P
Atkinson
University of Massachusetts Medical School, Worcester, MA, United States.
David
D
Blehar
Intermountain Medical Center and University of Utah, Salt Lake City, UT, United States.
Samuel M
SM
Brown
LSU Health Sciences Center, Baton Rouge, LA, United States.
Terrell
T
Caffery
Massachusetts General Hospital, Boston, MA, United States.
Emily
E
Douglass
Dalhousie University, Saint John, NB, Canada.
Jacqueline
J
Fraser
North Shore University Hospital, Manhasset, NY, United States.
Christine
C
Haines
Advocate Christ Medical Center, Chicago, IL, United States.
Samuel
S
Lam
Intermountain Medical Center and University of Utah, Salt Lake City, UT, United States.
Michael
M
Lanspa
Carolinas Medical Center, Charlotte, NC, United States.
Margaret
M
Lewis
Brown University, Providence, RI, United States.
Otto
O
Liebmann
Duke University School of Medicine, Durham, NC, United States.
Alexander
A
Limkakeng
Duke University School of Medicine, Durham, NC, United States.
Fernando
F
Lopez
Brigham and Women's Hospital, Boston, MA, United States.
Elke
E
Platz
University of Massachusetts Medical School, Worcester, MA, United States.
Michelle
M
Mendoza
Indiana University, Indianapolis, IN, United States.
Hal
H
Minnigan
Yale University School of Medicine, New Haven, CT, United States.
Christopher
C
Moore
NYU Bellevue Hospital, New York, NY, United States.
Joseph
J
Novik
Kingston General Hospital, Kingston, ON, Canada.
Louise
L
Rang
Castle Hospital, Kailua, HI, United States.
Will
W
Scruggs
North Shore University Hospital, Manhasset, NY, United States.
Christopher
C
Raio
D022561:Advanced Cardiac Life Support / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014463:Ultrasonography; D014481:United States
Cardiac arrest; Resuscitation; Ultrasound