The role of serial point-of-care ultrasound during cardiac arrest to predict termination of resuscitation
Abstract Background The decision to terminate cardiopulmonary resuscitation (CPR) remains challenging, particularly for patients with non-shockable rhythms (asystole/pulseless electrical activity). This study evaluated the role of serial point-of-care ultrasound (POCUS) in predicting the termination...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-07-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-025-01447-7 |
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| Summary: | Abstract Background The decision to terminate cardiopulmonary resuscitation (CPR) remains challenging, particularly for patients with non-shockable rhythms (asystole/pulseless electrical activity). This study evaluated the role of serial point-of-care ultrasound (POCUS) in predicting the termination of resuscitation by analyzing cardiac standstill duration. Methods A prospective cohort study was conducted from June 2024 to March 2025 in two academic hospitals. Adult patients (n = 154) with non-traumatic cardiac arrest (out-of-hospital or in-hospital) and non-shockable rhythms were included. Serial POCUS was performed every 2 min during CPR to assess cardiac activity. Demographics, arrest characteristics, and outcomes (death, return of spontaneous circulation [ROSC], survival to discharge) were recorded. Statistical analyses included ROC curves to determine predictive values of cardiac standstill duration for non-ROSC. Results The mean age of patients was 65.19 ± 11.63 years old (a range of 35–92) and 117 (76.0%) patients were male. ROSC occurred in 24.7% of cases, and 5.8% survived to discharge. Cardiac activity on initial POCUS was associated with higher ROSC rates (52.1% vs. 12.3%, p < 0.001) and survival (16.7% vs. 0.69%, p < 0.001). Cardiac standstill duration ≥ 10 min had 100% specificity and positive predictive value for non-ROSC. No patients with standstill ≥ 10 min achieved ROSC or survival. Conclusion Serial POCUS during CPR can effectively predict futile resuscitation, particularly when cardiac standstill persists ≥ 10 min. The absence of cardiac activity on initial POCUS and prolonged standstill were strongly associated with non-ROSC and mortality. These findings support integrating POCUS into resuscitation protocols to guide termination decisions, though larger studies are needed for validation. |
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| ISSN: | 1757-7241 |