Prognostic Impact of Point-of-Care Ultrasound in Patients With Suspected Cardiogenic Shock - A Systematic Review.

Abstract

Background: Cardiogenic shock, a life-threatening condition frequently encountered in emergency departments, requires rapid diagnosis and management. Point-of-care ultrasound (POCUS) is widely used as a bedside tool; however, its impact on prognosis in patients with suspected cardiogenic shock remains unclear. This systematic review aimed to evaluate whether POCUS improves the clinical outcomes in these patients.

Methods and results: We searched PubMed, Web of Science, and Cochrane Library up to December 31, 2023, for studies evaluating the prognostic impact of POCUS in adults with undifferentiated shock, including cardiogenic shock. From 3,759 identified records, 2 studies (1 randomized controlled trial [RCT] and 1 observational study) involving 5,711 patients with shock were included. The RCT showed no significant differences in in-hospital mortality between the POCUS and non-POCUS groups (relative risk [RR] 0.99 [95% confidence interval (CI) 0.64-1.51]). The observational study reported higher mortality in patients receiving POCUS before intervention (RR 1.25 [95% CI 1.12-1.39]). Overall, POCUS did not significantly reduce mortality in patients with suspected cardiogenic shock. Given the limited number and quality of available studies, the certainty of evidence was low (RCT) and very low (observational study).

Conclusions: Although POCUS plays an essential role in diagnosis and clinical decision-making, our review suggests that it may not significantly improve prognosis in patients with suspected cardiogenic shock. Further studies are required to determine its prognostic value.