Ultrasound ECG Cardiac Arrest

SHoC-ED2: Ultrasound and ECG findings as predictors of cardiac arrest outcomes in the emergency department

In Infographics, Medical Concepts by Simon Huang1 Comment

This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine that looks at the use of point-of-care ultrasound (PoCUS) and ECG findings in emergency department (ED) cardiac arrest patients. While current Advanced Cardiac Life Support (ACLS) protocols do not mandate the use of echocardiography, cardiac PoCUS is increasingly being used in ED cardiopulmonary resuscitation1,2. Studies have shown that an absence of cardiac activity on ultrasound is associated with a significantly lower likelihood of a return of spontaneous circulation (ROSC)3,4.

A study was conducted by Beckett et al. to see if combining ultrasound and ECG rhythm findings better predicted poor outcomes in cardiac arrest5. Specifically, they completed a health records review on ED cardiac arrest patients who underwent ultrasonography during resuscitation. Their primary outcome measurements included ROSC, survival to hospital admission and survival to hospital discharge.

The results are highlighted in our visual abstract. The use of PoCUS alone in predicting futility in non-shockable cardiac arrest was found to have a sensitivity of 96% and specificity of 34%5. By contrast, using ECG alone had a sensitivity of 83% and specificity of 47%. For patients with asystole on ECG, PoCUS had a sensitivity of 98% and specificity of 16%. In patients with PEA on ECG, PoCUS had a sensitivity of 87% and specificity of 55%.

Collectively, these results suggest the absence of cardiac activity on both ultrasound and ECG better predicts poor outcomes in non-shockable cardiac arrest.

To read the full article, visit https://doi.org/10.1017/cem.2019.397.

References:

  1. American College of Emergency Physicians. ACEP policy statement: emergency ultrasound guidelines. Ann Emerg Med. 2009;53:550-70.
  2. Atkinson P, Bowra J, Milne J, Lewis D, Lambert M, Jarman B, Noble VE, Lamprecht H, Harris T, Connolly J, Kessler R. International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest. CJEM. 2017 Nov;19(6):459-70.
  3. Blyth L, Atkinson P, Gadd K, Lang E. Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Acad Emerg Med. 2012;19:1119-26
  4. Tsou P-Y, Kurbedin J, Chen Y-S, Chou E, Lee M-t, Lee M,et al . Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis. Resuscitation. 2017;114:92-9
  5. Beckett N, Atkinson P, Fraser J, Banerjee A, French J, Talbot J-A, Stoica G, Lewis D. Do combined ultrasound and electrocardiogram-rhythm findings predict survival in emergency department cardiac arrest patients? The Second Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED2) Study. CJEM. 2019. Nov;21(6):739-43

Simon Huang

Simon Huang is a PGY1 FRCP-EM resident at Dalhousie University. He is the Associate Social Media Editor for CJEM and is involved with infographic creation for the CanadiEM website.

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- 3 years ago