心脏骤停期间连续床旁超声在预测复苏终止中的作用。
The role of serial point-of-care ultrasound during cardiac arrest to predict termination of resuscitation.
作者信息
Heydari Farhad, Nasr Isfahani Mehdi, Masoumi Babak, Khajebashi Sayed Hamed, Hajian Forough, Soleimani Fatemeh
机构信息
Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Health in Disasters and Emergencies, School of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
Scand J Trauma Resusc Emerg Med. 2025 Jul 24;33(1):129. doi: 10.1186/s13049-025-01447-7.
BACKGROUND
The decision to terminate cardiopulmonary resuscitation (CPR) remains challenging, particularly for patients with non-shockable rhythms (asystole/pulseless electrical activity). This study evaluated the role of serial point-of-care ultrasound (POCUS) in predicting the termination of resuscitation by analyzing cardiac standstill duration.
METHODS
A prospective cohort study was conducted from June 2024 to March 2025 in two academic hospitals. Adult patients ( = 154) with non-traumatic cardiac arrest (out-of-hospital or in-hospital) and non-shockable rhythms were included. Serial POCUS was performed every 2 min during CPR to assess cardiac activity. Demographics, arrest characteristics, and outcomes (death, return of spontaneous circulation [ROSC], survival to discharge) were recorded. Statistical analyses included ROC curves to determine predictive values of cardiac standstill duration for non-ROSC.
RESULTS
The mean age of patients was 65.19 ± 11.63 years old (a range of 35–92) and 117 (76.0%) patients were male. ROSC occurred in 24.7% of cases, and 5.8% survived to discharge. Cardiac activity on initial POCUS was associated with higher ROSC rates (52.1% vs. 12.3%, < 0.001) and survival (16.7% vs. 0.69%, < 0.001). Cardiac standstill duration ≥ 10 min had 100% specificity and positive predictive value for non-ROSC. No patients with standstill ≥ 10 min achieved ROSC or survival.
CONCLUSION
Serial POCUS during CPR can effectively predict futile resuscitation, particularly when cardiac standstill persists ≥ 10 min. The absence of cardiac activity on initial POCUS and prolonged standstill were strongly associated with non-ROSC and mortality. These findings support integrating POCUS into resuscitation protocols to guide termination decisions, though larger studies are needed for validation.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1186/s13049-025-01447-7.
背景
决定终止心肺复苏（CPR）仍然具有挑战性，尤其是对于非可电击心律（心脏停搏/无脉电活动）的患者。本研究通过分析心脏停搏持续时间，评估了连续床旁超声（POCUS）在预测复苏终止中的作用。
方法
2024年6月至2025年3月在两家学术医院进行了一项前瞻性队列研究。纳入非创伤性心脏骤停（院外或院内）且心律不可电击的成年患者（n = 154）。在心肺复苏期间每2分钟进行一次连续POCUS，以评估心脏活动。记录人口统计学、骤停特征和结局（死亡、自主循环恢复[ROSC]、出院存活）。统计分析包括ROC曲线，以确定心脏停搏持续时间对非ROSC的预测价值。
结果
患者的平均年龄为65.19±11.63岁（范围35 - 92岁），117名（76.0%）患者为男性。24.7%的病例出现ROSC，5.8%存活至出院。初始POCUS时的心脏活动与较高的ROSC率（52.1%对12.3%，P < 0.001）和存活率（16.7%对0.69%，P < 0.001）相关。心脏停搏持续时间≥10分钟对非ROSC具有100%的特异性和阳性预测值。没有心脏停搏≥10分钟的患者实现ROSC或存活。
结论
心肺复苏期间的连续POCUS可以有效预测无效复苏，特别是当心脏停搏持续≥10分钟时。初始POCUS时无心脏活动和长时间停搏与非ROSC和死亡率密切相关。这些发现支持将POCUS纳入复苏方案以指导终止决策，不过需要更大规模的研究进行验证。
补充信息
在线版本包含可在10.1186/s13049-025-01447-7获取的补充材料。
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