Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis

OBJECTIVE:We aim to summarize current evidence on the value of point-of-care (POC) focused echocardiography in the assessment of short-term survival in patients with cardiac arrest. METHODS:PubMed and EMBASE were searched from inception to July 2016 for eligible studies that evaluated the utility of POC echocardiography in patients with cardiac arrest. Modified QUADAS was used to appraise the quality of included studies. A random-effect bivariate model and a hierarchical summary receiving operating curve were used to summarize the performance characteristics of focused echocardiography. RESULTS:Initial search identified 961 citations of which 15 were included in our final analysis. A total of 1695 patients had POC echocardiography performed during resuscitation. Ultrasonography was mainly utilized to detect spontaneous cardiac movement (SCM) and identify reversible causes of cardiac arrest. Subcostal, apical and parasternal views were used to identify cardiac tamponade, pulmonary embolism, and pleural view for tension pneumothorax. Results of meta-analysis showed that SCM detected by focused echocardiography had a pooled sensitivity (0.95, 95%CI: 0.72-0.99) and specificity (0.80, 95%CI: 0.63-0.91) in predicting return of spontaneous circulation (ROSC) during cardiac arrest, with a positive likelihood ratio of 4.8 (95% CI: 2.5-9.4) and a negative likelihood ratio of 0.06 (95%CI: 0.01-0.39). CONCLUSION:POC focused echocardiography can be used to identify reversible causes and predict short-term outcome in patients with cardiac arrest. In patients with a low pretest probability for ROSC, absence of SCM on echocardiography can predict a low likelihood of survival and guide the decision of resuscitation termination.