American Red Cross Guidelines Database
TOPICS
< All Sections
Print

Intra-arrest Prognostication

Prognostication with Point-of-Care Echocardiography During CPR

Last Full Review: ILCOR 2020

A 2020 International Liaison Committee on Resuscitation (ILCOR) systematic review (Reynolds et al. 2020, 56) and Consensus on Science with Treatment Recommendations (Berg et al. 2020, s92) evaluated prognostication with use of point-of-care echocardiography during cardiopulmonary resuscitation (CPR) in adults with nontraumatic in-hospital or out-of-hospital cardiac arrest.

Red Cross Guidelines

  • Point-of-care ultrasonography may be considered for assessment of reversible etiologies of cardiac arrest.
  • Point-of-care ultrasonography should not have a role in prognostication for cardiac arrest.

 

Evidence Summary

All 15 studies in the ILCOR review were observational, and the overall certainty of evidence was rated as very low for multiple reasons including a high risk of bias (Berg et al. 2020, s92). Meta-analysis was not performed due to this and heterogeneity. There was difficulty in terms of the definition of cardiac motion as seen during point-of-care echocardiography, and the reviewers noted that a standardized definition of cardiac motion is needed for future studies (Berg et al. 2020, s92). The studies reported a wide range of sensitivities (i.e., 0.06 to 0.91) and specificities for cardiac motion in association with outcomes such as favorable outcome at hospital discharge, survival to hospital admission or discharge, or ROSC (Reynolds et al. 2020, 56).

A weak recommendation by ILCOR suggests against using point-of-care echocardiography for prognostication during CPR (Berg et al. 2020, s92).

Insights and Implications

Overall, this review did not identify a sonographic finding with sufficient and/or consistent sensitivity to apply to any clinical outcome for use as a sole criterion to terminate resuscitation. In addition, the use of point-of-care echocardiography depends on the availability of both equipment and a skilled operator and introduces added cost and potential to interrupt compressions during a cardiac arrest. Despite this, point-of-care echocardiography may be useful to diagnose certain causes of cardiac arrest that are treatable (i.e., tamponage, massive pulmonary embolism).