Does Cardiac Standstill on Early Focused Transthoracic Echocardiography Predict Absence of Return of Spontaneous
Andrea Breglia1, Ilaria Costantini2, Mirko Zanatta3
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy; Emergency Department, Cazzavillan Hospital, Arzignano, Vicenza, Italy.
Background:
Focused transthoracic echocardiography (TTE) during cardiopulmonary resuscitation (CPR) is a useful tool for the identification of reversible causes of cardiac arrest. Recent evidences also indicated a predictive function of focused TTE in distinguishing patients for whom resuscitation efforts may be futile.
Objectives:
The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of cardiac standstill, irrespective of the etiology and of presentation rhythm cardiac arrest, in identifying patients who are unlikely to achieve return of spontaneous circulation (ROSC).
Methods:
Population: we included adult patients (age ≥16 years) affected by either nontraumatic or traumatic cardiac arrest, with no restrictions regarding the setting.
Index Test:
performance of focused TTE during CPR, assessing the presence or absence of any wall or valve movement (cardiac standstill). Target condition: ROSC after cardiac arrest. We defined "Disease Positive" as death (ROSC-) and "Disease Negative" as ROSC achievement (ROSC+).
Results:
A total of 24 studies comprising 3684 patients were included. The pooled sensitivity and specificity of the cardiac standstill in predicting the absence of ROSC were 0.856 (95% CI 0.789-0.904) and 0.790 (95% CI 0.671-0.874), respectively. The calculated diagnostic odds ratio was calculated as 22.595 (95% CI 12.452-40.999). The summary receiver operating characteristic curve showed an area under the curve of 0.871 (95% CI 0.836-0.909), indicating a good diagnostic accuracy.
Conclusion:
Cardiac standstill has demonstrated considerable sensitivity, specificity, and odds ratio in predicting unsuccessful CPR.
Related Concept Videos
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:19Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart...
01:13The Cardiac Cycle
The Process
Electrical signals—sent from the sinoatrial (SA) node in the right atrial wall to the atrioventricular (AV) node between the right atrium and right ventricle—cause both atria to simultaneously contract. When the signal reaches the AV node, it pauses for approximately a tenth of a second, allowing the atria to contract and...
01:29Cardiac Cycle
During the cardiac cycle, blood flow through the heart is regulated entirely by changing pressure gradients. This sequence of events begins with the heart in a state of total relaxation, known as mid-to-late diastole, during which blood passively flows from...
01:17Exercise and Cardiac Output
Sustained exercise increases the muscles' oxygen demand, which can be...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...