Identifying cardiac activity using focused ultrasound in non-shockable arrests

Each year, around 60 000 people in the UK experience an out-of-hospital cardiac arrest. The introduction of additional diagnostic tools such as focused cardiac ultrasound (FoCUS) aids assessment and management of patients at the point of care. The Resuscitation Council guidance recommends its use where possible. A systematic literature search was undertaken of two databases, PubMed and Science Direct primarily to identify literature relevant to the use of ultrasound in medical cardiac arrests where the prevailing cardiac rhythm was non-shockable. A total of 10 papers were included in the review out of 242 identified from the search. Across all papers, three themes were identified: prognostication, identification of reversible causes and true pulseless electrical activity (PEA) versus pseudo PEA. The evidence shows there is an association between cardiac activity identified with FoCUS and an increase in return of spontaneous circulation (ROSC) rates. The effect of FoCUS for improving survival is not statistically significant; however, there is a higher likelihood of survival because of its ability to aid decision making. Patients with cardiac motion identified by FoCUS had higher ROSC rates than those without. Although the data suggest that the presence of cardiac activity is highly associated with ROSC, there is little literature surrounding long-term outcomes of patients, so the ability of FoCUS to determine survival cannot be confirmed.