• François Javaudin, Mathilde Papin, Quentin Le Bastard, Matthieu Thibault, Thomas Boishardy, François Brau, Said Laribi, Tomislav Petrovic, Tanguy Peluchon, Thibaut Markarian, Christelle Volteau, Idriss Arnaudet, Philippe Pes, and Philippe Le Conte.
• Service des Urgences, Centre Hospitalier Universitaire de Nantes, F-44000 Nantes, France; Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, UR 1155, F-44000 Nantes, France. Electronic address: francois.javaudin@chu-nantes.fr.
• Resuscitation. 2024 Aug 20: 110373110373.

IntroductionEarly assessment of the prognosis of a patient in cardiac arrest during cardiopulmonary resuscitation is highly challenging. This study aims to evaluate the predictive outcome value of early point-of-care ultrasound (POCUS) in out-of-hospital settings.MethodsThis observational, prospective, multicenter study's primary endpoint was the positive predictive value (PPV) of POCUS cardiac standstill within the first 12 minutes of advanced life support (ALS) initiation in determining the absence of return of spontaneous circulation (ROSC). A multivariate logistic regression model was constructed with adjustments for known predictive variables typically used in termination of resuscitation (TOR) rules.ResultsA total of 293 patients were analyzed, with a mean age of 66.6 ± 14.6 years, and a majority were men (75.8%). POCUS was performed on average 7.9 ± 2.6 minutes after ALS initiation. Among patients with cardiac standstill (72.4%), 16.0% achieved ROSC compared with 48.2% in those with visible cardiac motions. The PPV of early POCUS cardiac standstill for the absence of ROSC was 84.0%, 95% CI [78.3-88.6]. In multivariable analysis, only POCUS cardiac standstill (adjusted odds ratio [aOR] 3.89, 95% CI [1.86-8.17]) and end-tidal CO2 (ETCO2) value ≤ 37 mmHg (aOR 4.27, 95% CI [2.21-8.25]) were associated with the absence of ROSC.ConclusionEarly POCUS cardiac standstill during CPR for out-of-hospital cardiac arrest was a reliable predictor of the absence of ROSC. However, its presence alone was not sufficient to determine the termination of resuscitation efforts.Trial RegistrationClinicalTrials.gov Identifier: NCT03494153. Registered March 29, 2018.Copyright © 2024 Elsevier B.V. All rights reserved.

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