The role of serial point-of-care ultrasound during cardiac arrest to predict termination of resuscitation

Abstract

Background The decision to terminate cardiopulmonary resuscitation (CPR) remains challenging, particularly for patients with non-shockable rhythms (asystole/pulseless electrical activity). This study evaluated the role of serial point-of-care ultrasound (POCUS) in predicting the termination of resuscitation by analyzing cardiac standstill duration. Methods A prospective cohort study was conducted from June 2024 to March 2025 in two academic hospitals. Adult patients (n = 154) with non-traumatic cardiac arrest (out-of-hospital or in-hospital) and non-shockable rhythms were included. Serial POCUS was performed every 2 min during CPR to assess cardiac activity. Demographics, arrest characteristics, and outcomes (death, return of spontaneous circulation ROSC, survival to discharge) were recorded. Statistical analyses included ROC curves to determine predictive values of cardiac standstill duration for non-ROSC. Results The mean age of patients was 65.19 +/- 11.63 years old (a range of 35-92) and 117 (76.0%) patients were male. ROSC occurred in 24.7% of cases, and 5.8% survived to discharge. Cardiac activity on initial POCUS was associated with higher ROSC rates (52.1% vs. 12.3%, p < 0.001) and survival (16.7% vs. 0.69%, p < 0.001). Cardiac standstill duration >= 10 min had 100% specificity and positive predictive value for non-ROSC. No patients with standstill >= 10 min achieved ROSC or survival. Conclusion Serial POCUS during CPR can effectively predict futile resuscitation, particularly when cardiac standstill persists >= 10 min. The absence of cardiac activity on initial POCUS and prolonged standstill were strongly associated with non-ROSC and mortality. These findings support integrating POCUS into resuscitation protocols to guide termination decisions, though larger studies are needed for validation.