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evidence
literature review
treatment
technology
patient care
OHCA

Focused cardiac ultrasound in out-of-hospital cardiac arrest: a literature review

02 January 2021
Features
02 January 2021
Volume 13 · Issue 1

Abstract

Focused cardiac ultrasound (FoCUS) is emerging in emergency medical systems, particularly in the context of prognostication in out-of-hospital cardiac arrest. However, FoCUS has not been formally incorporated into UK guidelines because of a lack of evidence. Furthermore, concerns have been raised that FoCUS can distract people from providing other essential and evidenced elements of care. This broad literature search aims to shed light on the practice of FoCUS in cardiac arrest by reviewing articles related to in-hospital and out-of-hospital practice. The findings are conspicuous by the lack of high-quality studies, particularly regarding prognostication. Association between ultrasound findings and outcome are asserted, as is the feasibility of paramedic use of FoCUS, although the evidence is from small and non-randomised studies and subject to bias.

Although prehospital focused cardiac ultrasound (FoCUS) is becoming increasingly available to emergency medical services (EMS) in the UK and worldwide, there are concerns about the quality of evidence justifying its use. UK guidelines (Resuscitation Council (UK), 2015) state that, ‘when available for use by trained clinicians, focused echocardiography/ultrasound may be of use in assisting with diagnosis and treatment of potentially reversible causes of cardiac arrest’.

This diagnostic approach has not been incorporated into prehospital guidelines largely owing to the paucity of high-quality evidence (Quinn and Price, 2017). Following a more recent systematic review, numerous knowledge gaps and low certainty of evidence for using ultrasound in cardiac arrest have been highlighted (Reynolds et al, 2020).

It has been recognised that intra-arrest ultrasound can distract people from providing other essential elements of care, especially high-quality chest compressions (Gardner et al, 2018). Deakin and Koster (2016) highlight the significance of chest compression pauses being associated with decreased chances of survival.

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FoCUS
Cardiac arrest
Ultrasound
Prehospital
Advanced practice