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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

  • Nicole Beckett (a1) (a2) (a3), Paul Atkinson (a1) (a3), Jacqueline Fraser (a1), Ankona Banerjee (a1), James French (a1) (a3), Jo-Ann Talbot (a1) (a3), George Stoica (a4) and David Lewis (a1) (a3)...

Abstract

Objectives

Point-of-care ultrasound (POCUS) is used increasingly during resuscitation. The aim of this study was to assess whether combining POCUS and electrocardiogram (ECG) rhythm findings better predicts outcomes during cardiopulmonary resuscitation in the emergency department (ED).

Methods

We completed a health records review on ED cardiac arrest patients who underwent POCUS. Primary outcome measurements included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge.

Results

POCUS was performed on 180 patients; 45 patients (25.0%; 19.2%–31.8%) demonstrated cardiac activity on initial ECG, and 21 (11.7%; 7.7%–17.2%) had cardiac activity on initial POCUS; 47 patients (26.1%; 20.2%–33.0%) achieved ROSC, 18 (10.0%; 6.3%–15.3%) survived to admission, and 3 (1.7%; 0.3%–5.0%) survived to hospital discharge. As a predictor of failure to achieve ROSC, ECG had a sensitivity of 82.7% (95% CI 75.2%–88.7%) and a specificity of 46.8% (32.1%–61.9%). Overall, POCUS had a higher sensitivity of 96.2% (91.4%–98.8%) but a similar specificity of 34.0% (20.9%–49.3%). In patients with ECG-asystole, POCUS had a sensitivity of 98.18% (93.59%–99.78%) and a specificity of 16.00% (4.54%–36.08%). In patients with pulseless electrical activity, POCUS had a sensitivity of 86.96% (66.41%–97.22%) and a specificity of 54.55% (32.21%–75.61%). Similar patterns were seen for survival to admission and discharge. Only 0.8% (0.0–4.7%) of patients with ECG-asystole and standstill on POCUS survived to hospital discharge.

Conclusion

The absence of cardiac activity on POCUS, or on both ECG and POCUS together, better predicts negative outcomes in cardiac arrest than ECG alone. No test reliably predicted survival.

Objectif

On a de plus en plus recours à l’échographie au chevet (EC) durant les manœuvres de réanimation. L’étude visait donc à déterminer si l'association de l'EC et de l’électrocardiogramme (ECG) pour analyse du rythme avait une meilleure valeur prévisionnelle que l'ECG seul quant à l'issue durant les manœuvres de réanimation cardiorespiratoire au service des urgences (SU).

Méthode

Il s'agit d'un examen de dossiers médicaux de patients en état d'arrêt cardiaque qui ont été soumis à une EC au SU. Les principaux critères d’évaluation étaient le retour à la circulation spontanée (RCS), la survie en cours d'hospitalisation et la survie après le congé de l'hôpital.

Résultats

Une EC a été effectuée chez 180 patients; la présence d'activité électrique a été observée à l'ECG initial chez 45 d'entre eux (25,0%; 19,2–31,8%) et à l'EC initiale chez 21 d'entre eux (11,7%; 7,7–17,2%). Quarante-sept patients (26,1%; 20,2–33,0%) ont connu un RCS, 18 (10,0%; 6,3–15,3%) ont survécu à l'hospitalisation et 3 (1,7%; 0,3–5,0%) ont survécu au congé de l'hôpital. L'ECG a révélé une sensibilité de 82,7% (intervalle de confiance à 95% : 75,2%−88,7%) et une spécificité de 46,8% (32,1–61,9%) à l’égard de la valeur prévisionnelle du non-retour à la circulation spontanée. Dans l'ensemble, l'EC avait une sensibilité supérieure (96,2%; [(91,4–98,8%]) mais une spécificité comparable (34,0%; [(20,9–49,3%]) à celles de l'ECG. Chez les patients présentant une asystole à l'ECG, l'EC avait une sensibilité de 98,18% (93,59–99,78%) et une spécificité de 16,00,% (4,54–36,08%). Quant aux patients ayant une activité électrique sans pouls, l'EC avait une sensibilité de 86,96% (66,41–97,22%) et une spécificité de 54,55% (32,21–75,61%). Des résultats comparables ont été obtenus en ce qui concerne la survie en cours d'hospitalisation ainsi qu'après le congé de l'hôpital. Enfin, seulement 0,8% (0,0–4,7%) des patients présentant une asystole à l'ECG et un arrêt des contractions du cœur à l'EC ont survécu au congé de l'hôpital.

Conclusion

L'absence d'activité électrique cardiaque à l'EC seule ou à l'association de l'ECG et de l'EC a une meilleure valeur prévisionnelle que l'ECG seul quant à l'issue défavorable des

Copyright

Corresponding author

Correspondence to: Dr. Paul Atkinson, Emergency Department, Saint John Regional Hospital, 400 University Ave., Saint John, NB E2L 4L2; Email: Paul.Atkinson@Dal.Ca

Footnotes

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Both NB and PA contributed equally as primary authors.

Footnotes

References

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1.2005 American Heart Association guidelines for cardiopulmonary resuscitation: physiologic and educational rationale for changes. Mayo Clin Proc 2006;81(6):736–40.
2.American College of Emergency Physicians. ACEP policy statement: emergency ultrasound guidelines. Ann Emerg Med 2009;53:550–70.
3.Atkinson, P, Connolly, J, Jarman, R et al. Royal College of Emergency Medicine Learning. Ultrasound in Emergency Medicine – Level 1 Instruction. Available at: https://www.rcemlearning.co.uk/reference/ultrasound-in-emergency-medicine-level-1-instruction/ (accessed August 22, 2019).
4.Canadian Association of Emergency Physicians, Emergency Department Targeted Ultrasound Interest Group. Emergency department targeted ultrasound: 2006 update. CJEM 2006;8:170–1.
5.Atkinson, P, Bowra, J, Milne, J, et al. 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;19(6):459–70.
6.Hayhurst, C, Lebus, C, Atkinson, PR, et al. An evaluation of echo in life support (ELS): is it feasible? What does it add? Emerg Med J 2011;28:119–21.
7.Allison, MG, Bostick, DS, Fisher, KR, et al. Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation 2017;119:95–8.
8.Hernandez, C, Shuler, K, Hannan, H, et al. C.A.U.S.E.: cardiac arrest ultra-sound exam – a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation 2008;76(2):198206.
9.Andrus, P, Dean, A. Focused cardiac ultrasound. Global Heart 2013;8(4):299303.
10.Morrison, LJ, Visentin, LM, Kiss, A, et al. Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. N Engl J Med 2006;355(5):478–87.
11.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.
12.Tsou, P-Y, Kurbedin, J, Chen, Y-S, 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.
13.Blaivas, M, Fox, JC. Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram. Acad Emerg Med 2001;8(6):616–21.
14.Salen, P, Melniker, L, Chooljian, C, et al. Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients? Am J Emerg Med 2005;23(4):459–62.
15.Gaspari, R, Weekes, A, Adhikari, S, et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation 2016;109:33–9.
16.Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, Barta, DC, Steiner, J. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 1996;27(3):305–8.

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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

  • Nicole Beckett (a1) (a2) (a3), Paul Atkinson (a1) (a3), Jacqueline Fraser (a1), Ankona Banerjee (a1), James French (a1) (a3), Jo-Ann Talbot (a1) (a3), George Stoica (a4) and David Lewis (a1) (a3)...

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