Point of Care Focussed Echocardiography as a prognostication tool

In recently published systematic review, 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. There is currently not enough evidence and still very early on to consider focused echocardiography as a part of multimodal prognostication strategy [Tsou, 2017].

Fig. 1

Suggested prognostication algorithm. The algorithm is entered ≥72 h after ROSC if, after the exclusion of confounders (particularly residual sedation), the patient remains unconscious with a Glasgow Motor Score of 1 or 2. The absence of pupillary and corneal reflexes, and/or bilaterally absent N20 SSEP wave, indicates a poor outcome is very likely. If neither of the features is present, wait at least 24 h before reassessing. At this stage, two or more of the following indicate that a poor outcome is likely: status myoclonus ≤48 h; high neuron-specific enolase values; unreactive EEG with burst suppression or status epilepticus; diffuse anoxic injury on brain CT and/or MRI. If none of these criteria are met consider continue to observe and re-evaluate