Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest

Romolo Gaspari, Anthony Weekes, Srikar R Adhikari, Vicki E. Noble, Jason T. Nomura, Daniel Theodoro, Michael Woo, Paul Atkinson, David Blehar, Samuel M. Brown, Terrell Caffery, Emily Douglass, Jacqueline Fraser, Christine Haines, Samuel Lam, Michael Lanspa, Margaret Lewis, Otto Liebmann, Alexander Limkakeng, Fernando Lopez & 8 others Elke Platz, Michelle Mendoza, Hal Minnigan, Christopher Moore, Joseph Novik, Louise Rang, Will Scruggs, Christopher Raio

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background 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. Methods 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. Findings 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%). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)33-39
Number of pages7
JournalResuscitation
Volume109
DOIs
StatePublished - Dec 1 2016

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Point-of-Care Systems
Heart Arrest
Advanced Cardiac Life Support
Hospital Emergency Service
Survival
Pericardiocentesis
Pericardial Effusion
Resuscitation
Canada
Observational Studies
Survival Rate

Keywords

  • Cardiac arrest
  • Resuscitation
  • Ultrasound

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. / Gaspari, Romolo; Weekes, Anthony; Adhikari, Srikar R; Noble, Vicki E.; Nomura, Jason T.; Theodoro, Daniel; Woo, Michael; Atkinson, Paul; Blehar, David; Brown, Samuel M.; Caffery, Terrell; Douglass, Emily; Fraser, Jacqueline; Haines, Christine; Lam, Samuel; Lanspa, Michael; Lewis, Margaret; Liebmann, Otto; Limkakeng, Alexander; Lopez, Fernando; Platz, Elke; Mendoza, Michelle; Minnigan, Hal; Moore, Christopher; Novik, Joseph; Rang, Louise; Scruggs, Will; Raio, Christopher.

In: Resuscitation, Vol. 109, 01.12.2016, p. 33-39.

Research output: Contribution to journalArticle

Gaspari, R, Weekes, A, Adhikari, SR, Noble, VE, Nomura, JT, Theodoro, D, Woo, M, Atkinson, P, Blehar, D, Brown, SM, Caffery, T, Douglass, E, Fraser, J, Haines, C, Lam, S, Lanspa, M, Lewis, M, Liebmann, O, Limkakeng, A, Lopez, F, Platz, E, Mendoza, M, Minnigan, H, Moore, C, Novik, J, Rang, L, Scruggs, W & Raio, C 2016, 'Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest', Resuscitation, vol. 109, pp. 33-39. https://doi.org/10.1016/j.resuscitation.2016.09.018
Gaspari, Romolo ; Weekes, Anthony ; Adhikari, Srikar R ; Noble, Vicki E. ; Nomura, Jason T. ; Theodoro, Daniel ; Woo, Michael ; Atkinson, Paul ; Blehar, David ; Brown, Samuel M. ; Caffery, Terrell ; Douglass, Emily ; Fraser, Jacqueline ; Haines, Christine ; Lam, Samuel ; Lanspa, Michael ; Lewis, Margaret ; Liebmann, Otto ; Limkakeng, Alexander ; Lopez, Fernando ; Platz, Elke ; Mendoza, Michelle ; Minnigan, Hal ; Moore, Christopher ; Novik, Joseph ; Rang, Louise ; Scruggs, Will ; Raio, Christopher. / Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. In: Resuscitation. 2016 ; Vol. 109. pp. 33-39.
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abstract = "Background 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. Methods 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. Findings 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{\%}). Conclusion 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.",
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AU - Gaspari, Romolo

AU - Weekes, Anthony

AU - Adhikari, Srikar R

AU - Noble, Vicki E.

AU - Nomura, Jason T.

AU - Theodoro, Daniel

AU - Woo, Michael

AU - Atkinson, Paul

AU - Blehar, David

AU - Brown, Samuel M.

AU - Caffery, Terrell

AU - Douglass, Emily

AU - Fraser, Jacqueline

AU - Haines, Christine

AU - Lam, Samuel

AU - Lanspa, Michael

AU - Lewis, Margaret

AU - Liebmann, Otto

AU - Limkakeng, Alexander

AU - Lopez, Fernando

AU - Platz, Elke

AU - Mendoza, Michelle

AU - Minnigan, Hal

AU - Moore, Christopher

AU - Novik, Joseph

AU - Rang, Louise

AU - Scruggs, Will

AU - Raio, Christopher

PY - 2016/12/1

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N2 - Background 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. Methods 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. Findings 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%). Conclusion 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.

AB - Background 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. Methods 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. Findings 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%). Conclusion 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.

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KW - Resuscitation

KW - Ultrasound

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