Predicting Return of Spontaneous Circulation with Ultrasound-Guided Carotid Artery Compression During Chest Compressions
28 Pages Posted: 4 Dec 2024
Abstract
Objective: This study aimed to evaluate the diagnostic performance of intra-CPR Point-of-Care Ultrasound Carotid Artery Compression (POCUS-CAC) in predicting return of spontaneous circulation (ROSC) during chest compressions.Methods: A retrospective analysis was conducted on prospectively collected data from patients presenting to the emergency department with cardiac arrest between June 2022 and October 2023. POCUS-CAC was performed every 30 seconds during continuous chest compressions to assess carotid artery compressibility. A prediction of ROSC was recorded if the carotid artery remained non-compressible during both the systolic and diastolic phases. ROSC was confirmed using manual pulse palpation and electrocardiogram rhythm analysis every 2 minutes. The diagnostic performance of intra-CPR POCUS-CAC, including accuracy, sensitivity, and specificity, was assessed. Receiver operating characteristic analysis was performed. Multivariable analysis was used to determine factors associated with ROSC.Results: The study cohort included 37 patients, with a mean age of 71 years (standard deviation 18), and 57% were male. POCUS-CAC demonstrated 90.6% sensitivity, 87.2% accuracy, and an area under the curve (AUC) of 94.83% in predicting ROSC during rhythm checks conducted after two minutes of chest compressions. For final ROSC outcomes, POCUS-CAC had a sensitivity of 59.3% and specificity of 60.5%. Multivariable analysis identified POCUS-CAC as the strongest predictor of ROSC (odds ratio 39.25, 95% confidence intervals: 14.10–109.24, p < 0.0001).Conclusions: Intra-CPR POCUS-CAC demonstrated 87.2% accuracy and an AUC of 94.83% in predicting ROSC during chest compressions. This valuable, non-invasive tool may help facilitate faster ROSC determination, support real-time resuscitation adjustments, and enhance CPR quality monitoring.
Note:
Funding Declaration: This work was supported by a National Research Foundation of Korea (NRF) grant funded
by the Ministry of Science and ICT (MSIT) (NRF-2022R1C1C1011864).
Conflicts of Interest: None
Ethical Approval: This study was approved by the Institutional Review Board of the Samsung Medical Center (IRB file number 2024-10-109). The initial data collection was conducted under a consent- exempt protocol approved by the same board (IRB file number 2022-04-016). Informed consent was waived for both the initial data collection and the retrospective analysis, as both protocols were approved by the Institutional Review Board.
Keywords: Cardiopulmonary resuscitation, ultrasonography, Carotid artery, Return of Spontaneous Circulation
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