Does Cardiac Standstill on Early Focused Transthoracic Echocardiography Predict Absence of Return of Spontaneous Circulation in Cardiac Arrest? A Systematic Review and Meta-Analysis

Abstract

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.

Keywords: cardiac arrest; cardiac standstill; point-of-care echocardiography; point-of-care ultrasound; return of spontaneous circulation.