Can POCUS Improve Rhythm Identification and Outcomes in Out-of-Hospital Cardiac Arrests?

Electrocardiograms (ECGs) are used in every step of cardiac arrest resuscitation algorithms. However, during resuscitation, ECG artifacts or misinterpretations can lead to inaccurate rhythm identification and incorrect management paths. Researchers prospectively evaluated 811 U.S. and Canadian adults with out-of-hospital cardiac arrest with both ECG — with 1 to 3 leads — and cardiac point-of-care ultrasonography (POCUS) within the first 3 resuscitation pauses. Occult ventricular fibrillation (VF) was defined as VF seen on POCUS images but not via ECG.

Occult VF occurred in 5% of cardiac arrests. Patients with occult VF — compared with those who had ECG-identified VF — were significantly less likely to undergo defibrillation (30% vs. 54%). Su…