Point-of-care-ultrasound in in-hospital cardiac arrest

The purpose of this study was to investigate the relationship between point-of-care-ultrasound (POCUS) findings and survivorship and neurological outcomes at various time points within in-hospital cardiac arrest (IHCA).

We conducted a single center, prospective, observational study in a tertiary center with data collected between 2014 and 2025. A total of 169 patients were included. Protocolized ultrasound imaging was performed during resuscitation. The primary outcome was the association between different POCUS findings and achievement of ROSC. Secondary outcomes included survival at 1 h, 24 h, 48 h, hospital discharge, and 6 months, and neurological outcomes using cerebral performance category (CPC) scores: 1-2 as good and 3-5 as poor.

Compared to patients with true PEA, pseudo-PEA was associated with improved likelihood of ROSC (OR 3.31, 95% CI 1.52-7.21) and higher survival at 6 months (p = 0.003). Cardiac standstill was associated with significantly lower odds of ROSC (OR 0.10, 95% CI 0.05-0.21) and lower survival across all timepoints compared to patients with cardiac activity. Patients without RV stasis demonstrated higher survival proportions at all time points, although this did not reach statistical significance. No statistically significant associations were observed between ultrasound findings and neurological outcomes.

Cardiac standstill and RV stasis were associated with poorer survival in IHCA, while pseudo-PEA was associated with improved survival outcomes, when compared to true PEA. No significant association was observed between POCUS findings and neurological outcomes. Intra-arrest POCUS has implications for survival outcomes, but its role in predicting neurological recovery is an evolving area of investigation, requiring further studies.