Diagnostic performance of point-of-use ultrasound of resuscitation outcomes: A systematic review and meta-analysis of 3265 patients

Abstract

Background: Echocardiography in the setting of resuscitation can provide information as to the cause of the cardiac arrest, as well as indicators of futility. This systematic review and meta-analysis were performed to determine the value of point-of-care ultrasonography (PoCUS) in the assessment of survival for adult patients with cardiac arrest.

Methods: This meta-analysis was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Web of Science, Cochrane have been searched from databases inception until March 2nd 2021. The search was limited to adult patients with cardiac arrest and without publication dates or country restrictions. Papers were chosen if they met the required criteria relating to the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this diagnostic technique concerning resuscitation outcomes.

Results: This systematic review identified 20 studies. Overall, for survival to hospital discharge, PoCUS was 6.2% sensitivity (95% confidence interval [CI] 4.7-8.0%) and 2.1% specific (95% CI 0.8-4.2%). PoCUS sensitivity and specificity for return of spontaneous circulation were 23.8% (95% CI 21.4-26.4%) and 50.7% (95% CI 45.8-55.7%) respectively, and for survival to admission 13.8% (95% CI 12.2-15.5%) and 20.1% (95% CI 16.2-24.3%), respectively.

Conclusions: The results do not allow unambiguous recommendation of PoCUS as a predictor of resuscitation outcomes and further studies based on a large number of patients with full standardization of operators, their training and procedures performed were necessary.

Keywords: cardiac arrest; cardiopulmonary resuscitation; echocardiography; meta-analysis; outcome; systematic review; ultrasonography.

Figure 1

Meta-analysis flow chart of included and excluded studies.

Figure 2

Forrest plot of the overall sensitivity and specificity of echocardiography for predicting survival to hospital discharge after cardiac arrest; CI — confidence interval; TP — true positive; FP — false positive; FN — false negative; TN — true negative.

Figure 3

Forrest plot of the overall sensitivity and specificity of echocardiography for predicting the return of spontaneous circulation after cardiac arrest; CI — confidence interval; TP — true positive; FP — false positive; FN — false negative; TN — true negative.

Figure 4

Forrest plot of the overall sensitivity and specificity of echocardiography for survival to hospital admission after cardiac arrest; CI — confidence interval; TP — true positive; FP — false positive; FN — false negative; TN — true negative.