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Ultrasound During CPR

Question Type:
Full Question:
Among adults who are in cardiac arrest in any setting (P), does does use of ultrasound (including echocardiography or other organ assessments) during CPR  (I), compared with compared with conventional CPR and resuscitation without use of ultrasound  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC (O)?
Consensus on Science:
For the critical outcome of survival, we identified 1 observational study.(Prosen 2010, 1458) The evidence was downgraded for very high risk of bias (significant confounding, selection bias) and imprecision (small sample size). Therefore, we concluded that the data do not provide enough evidence to address the PICO question. For the important outcome of ROSC, we identified very-low-quality evidence (downgraded for imprecision [small sample size] and very high risk of bias [no information about randomization allocation, lack of blinding, lack of blinding in outcome assessors]) from 1 RCT investigating the use of cardiac ultrasound during ACLS, compared with no use of cardiac ultrasound during ACLS in adult patients with pulseless electrical activity arrest.(Chardoli 2012, 284) This study enrolled 100 patients in a convenience sample and reported ROSC for at least 10 seconds in 34% of patients in the ultrasound group versus 28% in the group with no ultrasound (P=0.52).
Treatment Recommendation:
We suggest that if cardiac ultrasound can be performed without interfering with standard ACLS protocol, it may be considered as an additional diagnostic tool to identify potentially reversible causes (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation we have placed a higher value on the potential harm from interruptions in chest compressions. There is currently inadequate evidence to evaluate whether there is any benefit of cardiac ultrasound during ACLS. Although this was not specifically part of the question, the task force discussed the importance of the need for an individual trained in ultrasound during resuscitation to minimize interruption in chest compression. The task force agreed there will be circumstances where ultrasound identification of a potentially reversible cause of cardiac arrest or ‘pseudo’ pulseless electrical activity may be useful.

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