Phantom Scanning in Point-of-Care Ultrasound After Out-of-Hospital Cardiac Arrest: Impact of Clinical Presentation in a Single-Center Analysis

Abstract

Background

Phantom scanning, defined as the use of point-of-care ultrasound (POCUS) without image archiving, occurs frequently in cardiac arrest and carries clinical, legal, and quality improvement consequences. Its association with clinical presentation following out-of-hospital cardiac arrest (OHCA) remains understudied.

Objectives

To evaluate the prevalence of phantom scanning in OHCA, stratified by clinical presentation and emergency department (ED) disposition.

Methods

We conducted a retrospective, single-center study of adult patients presenting with atraumatic OHCA. The primary outcome was phantom scanning among patients presenting with cardiopulmonary resuscitation (CPR) in progress versus return of spontaneous circulation (ROSC). The secondary outcome compared phantom scanning between admitted patients versus those who died in the ED. Descriptive statistics, chi-square tests, and odds ratios with 95% confidence intervals evaluated associations.

Results

Of 306 patients reviewed, 244 met inclusion criteria. POCUS was more likely with CPR in progress (OR = 3.58, 95% CI [2.08, 6.26], p < 0.001). Among patients who underwent POCUS, phantom scanning was more frequent with CPR in progress (OR = 3.15, 95% CI [1.49, 6.84], p = 0.002). POCUS was less likely among admitted patients (OR = 0.37, 95% CI [0.21, 0.66], p < 0.001), and phantom scanning was less common in this group (OR = 0.23, 95% CI [0.11, 0.47], p < 0.001). Differences in POCUS use and phantom scanning were significant by both presentation and disposition (p < 0.001).

Conclusion

Phantom scanning occurred more often in OHCA patients with CPR in progress and in those who died in the ED. Future research should focus on strategies to reduce phantom scanning and promote adherence to POCUS best practices.