Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis
Journal
Resuscitation
Journal Volume
114
Pages
92-99
Date Issued
2017
Author(s)
Tsou P.-Y.
Kurbedin J.
Chen Y.-S.
Chou E.H.
Lee M.-T.G.
Lee M.C.-H.
Abstract
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. ? 2017 Elsevier B.V.
Other Subjects
diagnostic accuracy; echocardiography; heart arrest; heart movement; heart tamponade; hospital admission; human; lung embolism; meta analysis; outcome assessment; point of care testing; priority journal; quantitative analysis; resuscitation; return of spontaneous circulation; Review; sensitivity and specificity; short term survival; spontaneous cardiac movement; systematic review; tension pneumothorax; diagnostic imaging; echocardiography; echography; mortality; Out-of-Hospital Cardiac Arrest; point of care system; procedures; prospective study; resuscitation; retrospective study; Cardiopulmonary Resuscitation; Echocardiography; Humans; Out-of-Hospital Cardiac Arrest; Point-of-Care Systems; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; Ultrasonography
Type
review