Use of Point-of-Care Ultrasound During Cardiac Arrest in the Emergency Department: A Multicentre Retrospective Study

Point-of-care ultrasound (POCUS) is widely used in emergency departments (ED) and has potential value during cardiac arrest for identifying reversible causes (e.g., pericardial effusion, pneumothorax and pulmonary embolism) and guiding resuscitation. However, its role remains inconsistently applied. This study describes the use of POCUS during ED cardiac arrests, including frequency, association with rhythm type and impact on interventions.

A retrospective review was conducted across three Sydney EDs from November 2020 to October 2023 (3 years). Patients were included if they received CPR in the ED; those with resuscitation ceased on arrival under an advanced directive were excluded. Data collected included demographics, presenting rhythm, POCUS use, interventions prompted by POCUS findings and outcomes.

Of 528 cardiac arrests, 257 met inclusion criteria. Median age was 66 years (IQR:54-80), with 67% male. Nonshockable rhythms were present in 159 (62%). POCUS was performed in 196 (76%): 76/98 (78%) with shockable rhythms and 119/159 (75%) with nonshockable rhythms. A reversible cause was identified in six: four pericardial effusions (treated with pericardiocentesis) and two suspected pulmonary emboli (treated with thrombolysis). No patient achieved return of spontaneous circulation following intervention. Overall survival to discharge was 12/257 (5%): 7/98 (7%) in shockable rhythms and 5/159 (3%) in nonshockable rhythms.

POCUS was commonly used during cardiac arrest and identified reversible pathology in a small number; however, these findings did not alter outcomes. While POCUS can assist in identifying reversible causes, its use must not disrupt high-quality chest compressions, which remain the cornerstone of cardiac arrest management.