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Identifying cardiac activity using focused ultrasound in non-shockable arrests

02 July 2022
Volume 12 · Issue 2



Each year, around 60 000 people in the UK experience an out-of-hospital cardiac arrest. The introduction of additional diagnostic tools such as focused cardiac ultrasound (FoCUS) aids assessment and management of patients at the point of care. The Resuscitation Council guidance recommends its use where possible.


A systematic literature search was undertaken of two databases, PubMed and Science Direct primarily to identify literature relevant to the use of ultrasound in medical cardiac arrests where the prevailing cardiac rhythm was non-shockable.


A total of 10 papers were included in the review out of 242 identified from the search. Across all papers, three themes were identified: prognostication, identification of reversible causes and true pulseless electrical activity (PEA) versus pseudo PEA.


The evidence shows there is an association between cardiac activity identified with FoCUS and an increase in return of spontaneous circulation (ROSC) rates. The effect of FoCUS for improving survival is not statistically significant; however, there is a higher likelihood of survival because of its ability to aid decision making. Patients with cardiac motion identified by FoCUS had higher ROSC rates than those without. Although the data suggest that the presence of cardiac activity is highly associated with ROSC, there is little literature surrounding long-term outcomes of patients, so the ability of FoCUS to determine survival cannot be confirmed.

Each year, around 60 000 people in the UK experience an out-of-hospital cardiac arrest (Fisher, 2020). Despite improvements in cardiopulmonary resuscitation and the use of evidence-based interventions, the average survival to hospital discharge for cardiac arrest out of hospital in England is 8.6% (Resuscitation Council, 2015).

The introduction of additional diagnostic tools, such as focused cardiac ultrasound (FoCUS), aid treatment and management of patients at the point of care (Andrus and Dean, 2013). FoCUS is an investigative tool that examines cardiac function with a portable device at the point of care (Andrus and Dean, 2013). The Resuscitation Council published guidance in 2021 on the use and importance of FoCUS in cardiac arrest management by trained clinicians (Soar et al, 2021a).

Multiple terms are used when speaking about ultrasound, for example echocardiography, sonography and point-of-care ultrasound as well as FoCUS. These all relate to the use of a probe to examine the heart and its structures through sound waves to create an image of the internal structures. Although mainly used to detect traumatic injury, ultrasound can also be used to assess myocardial contractility in cardiac arrests (Andrus and Dean, 2013; Blanco and Martínez Buendía, 2017).

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