Aim

Point-of-care ultrasound (POCUS) has been shown to assist in predicting outcomes in cardiac arrest. We evaluated the test characteristics of POCUS in predicting poor outcomes: failure of return of spontaneous circulation (ROSC), survival to hospital admission (SHA), survival to hospital discharge (SHD) and neurologically intact survival to hospital discharge (NISHD) in adult and paediatric patients with blunt and penetrating traumatic cardiac arrest (TCA) in out-of-hospital or emergency department settings.

Methods

We conducted a systematic review and meta-analysis using the PRISMA guidelines. We searched Clinicaltrials.gov, CINAHL, Cochrane library, EMBASE, Medline and the World Health Organization-International Clinical Trials Registry from 1974 to November 9, 2020. Risk of bias was assessed using QUADAS-2 tool. We used a random-effects meta-analysis model with 95% confidence intervals with I² statistics for heterogeneity.

Results

We included 8 studies involving 710 cases of TCA. For all blunt and penetrating TCA patients who failed to achieve ROSC, the specificity (proportion of patients with cardiac activity on POCUS who achieved ROSC) was 98% (95% CI 0.13 to 1.0). The sensitivity (proportion of patients with cardiac standstill on POCUS who failed to achieve ROSC) was 91% (95% CI 0.67 to 0.98). No patient with cardiac standstill survived. Substantial level of heterogeneity was noted.

Conclusions

Patients in TCA without cardiac activity on POCUS have a high likelihood of death and negligible chance of SHD. The numbers of patients included in published studies remains too low for practice recommendations for termination of resuscitation based solely upon the absence of cardiac activity on POCUS.

中文翻译：

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床旁超声是创伤性心脏骤停期间结果的可靠预测指标吗？SHoC 研究人员的系统评价和荟萃分析

目的

床旁超声 (POCUS) 已被证明有助于预测心脏骤停的结果。我们评估了 POCUS 在预测不良结果方面的测试特征：成人和成人患者自主循环恢复失败 (ROSC)、入院存活率 (SHA)、出院存活率 (SHD) 和神经功能完好出院存活率 (NIHSD)。在院外或急诊科环境中患有钝性和穿透性创伤性心脏骤停 (TCA) 的儿科患者。

方法

我们使用 PRISMA 指南进行了系统评价和荟萃分析。我们检索了 1974 年至 2020 年 11 月 9 日的 Clinicaltrials.gov、CINAHL、Cochrane 图书馆、EMBASE、Medline 和世界卫生组织-国际临床试验注册中心。使用 QUADAS-2 工具评估了偏倚风险。我们使用具有 95% 置信区间和I ²统计异质性的随机效应荟萃分析模型。

结果

我们纳入了 8 项研究，涉及 710 例 TCA。对于所有未能达到 ROSC 的钝性和穿透性 TCA 患者，特异性（在 POCUS 上有心脏活动的患者达到 ROSC 的比例）为 98%（95% CI 0.13 至 1.0）。敏感性（在 POCUS 上心脏停顿但未能达到 ROSC 的患者比例）为 91%（95% CI 0.67 至 0.98）。没有心脏停止的患者存活。注意到了很大程度的异质性。

结论

在 POCUS 上没有心脏活动的 TCA 患者死亡的可能性很高，SHD 的可能性可以忽略不计。已发表研究中包括的患者数量仍然太少，无法根据 POCUS 上没有心脏活动来终止复苏的实践建议。