Intravascular Clotting Detected in Point-of-care Ultrasound as a Marker of the Timing and Severity of Cardiac Arrest and an Indicator of Futile Resuscitation

Introduction:

More than one million sudden cardiac arrests requiring cardiopulmonary resuscitation (CPR) occur each year in the United States and Europe. A point-of-care test to assess prognosis during resuscitation is a desirable clinical tool. Post-mortem intravascular clotting is considered an early sign of death. The detection of signs of clotting (spontaneous echo contrast or thrombus) in the cardiac cavities in an ultrasound examination during resuscitation may be an indicator of the severity of cardiac arrest and a marker of futile resuscitation. Performing transthoracic echocardiography during resuscitation is only possible during short breaks to assess the heart rhythm and pulse. Research shows that the use of transthoracic examination might cause additional interruptions in chest compressions. The use of a transesophageal examination, which can be performed during compressions, is only possible in specialized centers.

An examination that allows for the detection of intravascular clotting and at the same time does not require interruption of chest compressions is ultrasound assessment of deep veins. There is no data in the literature on the time that must pass from cardiac arrest to the occurrence of intravascular clotting, the frequency of clotting in deep veins during resuscitation and its importance for the resuscitation outcome.

Confirmation of the usefulness of the ultrasound-detected clotting in deep veins during resuscitation in assessing the severity of cardiac arrest and the prognosis of resuscitation, which is the aim of the project, will have an impact on international guidelines for determining the prognosis and potential futility of resuscitation.

Objectives of the study: