Point of Care Focussed Echocardiography as a prognostication tool

Post-resuscitation myocardial dysfunction and low cardiac index may occur in up to 60 % of post-cardiac arrest patients and may be even more common in patients with an acute myocardial infarction (AMI) as the cause of the arrest. [2]

Early echocardiography can identify underlying cardiac pathology (as possible cause of cardiac arrest), quantify the degree of myocardial dysfunction and help guide haemodynamic management.

However, evidence for its use in prognostication is limited. A systematic review in 2017 by Tsou, et al. [10] showed patients with a low pre-test probability for ROSC and absence of spontaneous cardiac movement on echocardiography can predict a low likelihood of survival and can guide the decision of resuscitation termination.

Two other, more recent studies showed no clear association of low cardiac output (or index) and poor outcome – sub study of TTM2 showed if lactate clearance is maintained then low cardiac index may not be associated with poor outcome. A further sub study of the Blood Pressure and Oxygenation Targets After OHCA (BOX) trial, in a multivariable analysis, showed a low cardiac index at admission was not associated with increased mortality.