Echocardiography for prognostication during the resuscitation ofintensive care unit patients with non-shockable rhythm cardiacarrest

ABSTRACT

Aim: Transthoracic echocardiography (TTE) during cardiopulmonary arrest (CPA) has been studied invictims of cardiac arrests. Our objective was to evaluate the feasibility and usefulness of TTE in victimsof cardiac arrest with non-shockable rhythms hospitalized in intensive care units (ICUs).Methods: This prospective and observational cohort study evaluated ICU patients with CPA in asystole orpulseless electrical activity (PEA). Intensivists performed TTE during intervals of up to 10 s as establishedin the treatment protocol. Myocardial contractility was defined as intrinsic movement of the myocardiumcoordinated with cardiac valve movement. PEA without contractility was classified as electromechanicaldissociation (EMD), and with contractility as pseudo-EMD. The images, the rates of return of spontaneouscirculation (ROSC) and the survival upon hospital discharge and after 180 days were evaluated.Results: A total of 49 patients were included. Image quality was considered adequate in all cases andcontributed to the diagnosis of CPA in 51.0% of the patients. Of the 49 patients included, 17 (34.7%) werein asystole and 32 (65.3%) in PEA, among which 5 (10.2%) were in EMD and 27 (55.1%) in pseudo-EMD.The rates of ROSC were 70.4% for those in pseudo-EMD, 20.0% for those in EMD, and 23.5% for those inasystole. Survival upon hospital discharge and after 180 days occurred only in patients in pseudo-EMD(22.2% and 14.8%, respectively).Conclusions: TTE conducted during cardiopulmonary resuscitation in ICU patients can be performed withoutinterfering with care protocols and can contribute to the differential diagnosis of CPA and to theidentification of a subgroup of patients with better prognosis.