The Role of Cardiac Arrest Sonographic Exam (CASE) inPredicting the Outcome of Cardiopulmonary Resuscita-tion; a Cross-sectional Study

Ultrasonography (US) has been suggested as an integral part of resuscitation to identify poten-tially reversible causes of cardiac arrest (CA). This study aimed to evaluate the association between cardiac ac-tivity on ultrasonography during resuscitation and outcome of patients with non-shockable rhythms.

We conducted a prospective, observational study on adult patients presenting with CA or experiencing CA inthe emergency department (ED), and initial non-shockable rhythm. US examination of the sub-xiphoid regionwas performed during the 10-second interval of rhythm and pulse check and the association of US findings andpatients’ outcomes was evaluated.

151 patients with the mean age of 65.32 ± 11.68 years were evaluated(76.2% male). 43 patients (28.5%) demonstrated cardiac activity on the initial US. The rate of asystole in initialrhythm was 58.9% (n=89). Return of spontaneous circulation (ROSC) was achieved in 36 (23.8%) patients, twenty(13.2%) survived to hospital admission and seven (4.6%) survived to hospital discharge. When the cardiac stand-still duration increased to six minutes, no patient survived hospital discharge. Potentially reversible causes weredetected in 15 cases (9.9%), and four of them survived to hospital discharge. Cardiac activity on first scan wasassociated with ROSC (OR: 6.86, 95%CI: 2.92-16.09; p < 0.001), survival to hospital admission (OR: 17.80, 95%CI:3.95–80.17; p < 0.001), and survival to hospital discharge (OR: 17.35, 95%CI: 2.02–148.92; p = 0.001).

Conclusion:

In non-traumatic cardiac arrest patients with non-shockable rhythms, bedside US is of great importancein predicting ROSC. The presence of pulseless electrical activity (PEA) rhythm and cardiac activity on initial USwere associated with ROSC, survival to hospital admission, and hospital discharge. When the cardiac standstillduration increased to six minutes, no patient survived hospital discharge.