Outcome in cardiac arrest patients found to have cardiac standstill on thebedside emergency department echocardiogram

Patients presenting in cardiac arrest frequently have poor outcomes despite heroic resuscitative measures in the field. Many emergency medical systems have protocols in place to stop resuscitative measures in the field; howev er, further predictors need to be developed for cardiac arrest patients bro ught to the emergency department (ED). Objective: To examine the predictive value of cardiac standstill visualized on bedside ED echocardiograms durin g the initial presentations of patients receiving cardiopulmonary resuscita tion (CPR). Methods: The study took place in a large urban community hospit al with an emergency medicine residency program and a high volume of cardia c arrest patients. As part of routine care, all patients arriving with CPR in progress were subject to immediate and brief subxiphoid or parasternal c ardiac ultrasound examination. This was followed by brief repeat ultrasound examination during the resuscitation when pulses were checked. A 2.5-MHz p hased-array probe was used for imaging. Investigators filled out standardiz ed data sheets. Examinations were taped for review. Statistical analysis in cluded descriptive statistics, positive and negative predictive values, and likelihood ratios. Results: One hundred sixty-nine patients were enrolled in the study. One hundred thirty-six patients had cardiac standstill on the initial echocardiogram. Of these, 71 patients had an identifiable rhythm o n monitor. No patient with sonographically identified cardiac standstill su rvived to leave the ED regardless of his or her initial electrical rhythm. Cardiac standstill on echocardiogram resulted in a positive predictive valu e of 100% for death in the ED, with a negative predictive value of 58%. Con clusions: Patients presenting with cardiac standstill on bedside echocardio gram do not survive to leave the ED regardless of their electrical rhythms. This finding was uniform regardless of downtime. Although larger studies a re needed, this may be an additional marker for cessation of resuscitative efforts.