ResUS in the Literature: Serial FEEL and Termination of Resuscitation

Journal: Resuscitation

Date:April 2016

Format: Prospective Observational Study

Method: A prospective observational study of non-consecutive non-trauma adult patients with out of hospital cardiac arrest (OHCA) using the ResUS FEEL protocol. ResUS was performed every two minutes during pulse check for <10s throughout resuscitation and findings were recorded as video clips.

Results: 

• 48 patients enrolled
• ROSC patients had standstill for 2.86 ± 2.07min
• Non-ROSC patients had standstill for 20.30 ± 8.42min
• Standstill ≥10min predicts non-ROSC with a sensitivity of 90.0% and specificity of 100%.
• The presence of cardiac activity on initial FEEL was not identified in 40 patients, but 21 had ROSC. 

Figure: A receiver operating characteristic (ROC) curve determining the accuracy of serial echocardiographic cardiac standstill duration for predicting non-return of spontaneous circulation. The area under the receiver operating characteristic curve is 0.991 (p < 0.001).


Commentary: We have seen previously that loss of cardiac activity on ResUS is a strong negative predictor of ROSC. Current study authors note cardiac standstill on initial ResUS could not predict non-ROSC and cannot be used as a TOR rule, arguing that serial ResUS can better determine ROSC.

Of note in this study:
-clinicians were not blinded to the echocardiography findings (bias). 
-patients were committed to the same 30 min duration of resuscitation
-efforts were terminated early in no patients.
-unlike other studies, videos were recorded and reviewed

Question:
What was the duration of cardiopulmonary resuscitation prior to ED arrival?

References:

Kim HB, Suh JY, Choi JH, Cho YS. Can serial focussed echocardiographic evaluation in life support (FEEL) predict resuscitation outcome or termination of resuscitation (TOR)? A pilot study. Resuscitation. 2016 Apr;101:21-6.