Table 2 Summary of the included studies
Author/year Country Design | Inclusion Exclusion Setting | Ultrasound timing Cardiac activity definition Operator | Machine Probe Windows | Outcomes |
|---|---|---|---|---|
Masoumi 2021 |  > 18 yo, OHCA & EDCA, non-traumatic cause, non-shockable rhythm | During the first 3 CPR pauses < 10 s, treating clinicians were not blinded to US findings except for cardiac motion | Philips Affiniti 70 | n = 151 ROSC |
Iran | Resuscitation < 4 min (n = 10), US not done (n = 9), other reasons (n = 5) | Any visible atrial, valvular, or ventricular movement, excluding movement of blood within cardiac chambers or isolated valve movement | Curvilinear | SHA |
POS | 2 urban EDs | 5 EPs with > 6 years of experience in emergency echocardiography | SC | SHD |
Devia 2020 |  > 18 yo, OHCA and EDCA, non-traumatic cause, PEA rhythm | Not mentioned | SonoSite M-Turbo | n = 56 ROSC |
Colombia | Trauma, referred to other institutions through administrative request | Not mentioned | Phased array | 24-h survival |
ROS | Single-center ED | Not mentioned | SC, PSLA, A4C or A5C | SHD |
Atkinson 2019 |  > 19 yo, OHCA, non-traumatic cause, non-shockable rhythm | Designated pauses (pulse/rhythm checks, intubation) minimized as per ACLS | Not mentioned | n = 180 ROSC |
Canada | US not done (n = 43), < 19 yo, IHCA, DNR | Sustained coordinated contractility of LV, with visible valve movement | Curvilinear, Phased array | SHA |
ROS | Tertiary center ED | Credentialed EPs (CPOCUS/CEUS/IFEM) | SC, PSLA, A4C | SHD |
Israr 2019 |  > 18 yo, OHCA, traumatic cause, PEA rhythm | Not mentioned | Not mentioned | n = 79 |
USA | US not done (n = 31), medical cause | Not mentioned | Not mentioned | SHA |
ROS | 2 level-1 trauma centers | Trauma surgeons | Not mentioned | SHD |
Lien 2018 | OHCA, non-traumatic cause, shockable & non-shockable rhythm | Pulse/rhythm every 2-min check < 10 s | Toshiba SSA-550A | n = 177 ROSC |
Taiwan | DNR (n = 56), US not done [29], US not complete [2], tracheostomy [8], neck tumors [2], neck operation, pregnancy | Not mentioned | Curvilinear |  |
POS | Tertiary center ED | 10 EPs who attended basic emergency US training & 4Â h focused training | SC | SHD |
Khunkhlai 2017 | OHCA, non-traumatic cause, shockable & non-shockable rhythm | On ED arrivals and 5 repetitive scans every 2 min during CPR pause | Not mentioned | n = 63 ROSC |
Thailand | Not mentioned | Cardiac wall AND/OR valvular movement | Not mentioned | SHA |
POS | Single-center ED | Not mentioned | Not mentioned | 30-day survival |
Chua 2017 |  > 21 yo, OHCA, non-traumatic cause, shockable & non-shockable rhythm | Pulse checks < 10 s. If the leader decided to continue resuscitation in < 10 s, US would cease | SonoSite Edge II & Terason | n = 101 |
Singapore | Pregnant, terminally ill, EDCA (n = 53), DNR [15], ROSC on ED arrival [18] | Not mentioned | Not mentioned | SHA |
POS | Tertiary center ED | Senior residents and above completed training program (detailed in the paper) | Not mentioned | SHD |
Gaspari 2016 | OHCA & EDCA, non-traumatic cause, non-shockable rhythm | Pulse/rhythm check at beginning of ACLS in ED and 2nd US at end of resuscitation | Not mentioned | n = 793 ROSC |
USA Canada | Resuscitation ended after US (n = 106), no ACLS meds given (n = 42), DNR [8], incomplete timing data [3], unable to interpret US [1] | Any visible movement of the myocardium, excluding movement of blood within the cardiac chambers or isolated valve movement | Not mentioned | SHA |
POS | Multicenter (20 EDs) | EPs credentialed in bedside US by their individual hospitals | SC, PSLA | SHD |
Kim 2016 | Convenience sampling, > 18 yo, OHCA, non-traumatic cause, shockable & non-shockable rhythm | During pulse checks every 2 min < 10 s Patients were committed to 30 min of resuscitation | GE LOGIQ S6 | n = 48 ROSC |
Korea | No sonographer (n = 142), < 18 yo [7], trauma [24], drug intoxication [1] | Any detected atrial, valvular, or ventricular motion within the heart | Phased array |  |
POS | Tertiary center ED | 2 senior residents & 3 EM specialists with ≥ 3 years of experience in emergency echo | SC, PS | SHD |
Zengin 2016 |  > 18 yo, OHCA & EDCA, non-traumatic cause, shockable and non-shockable rhythm | Femoral pulse check < 10 s, for 3 inspections | GE Logiq P6 | n = 179 ROSC |
Turkey | Trauma (n = 51), technical & anatomical reasons (n = 27), no sonographer (n = 7) | Any detected motion of the myocardium, ranging from visible VF to coordinated ventricular contractions | Tightly-curved |  |
POS | Single-center ED | 2 senior doctors with 16Â h of theoretical and applied focused echo training & 8Â h of basic emergency US training | SC, PS, A4C | SHD |
Ozen 2016 | Convenience sampling, > 18 yo, OHCA & EDCA, traumatic and non-traumatic cause, shockable and non-shockable rhythm | Pulse checks | Hitachi Aloka Prosound 6 | n = 129 ROSC |
Turkey |  < 18 yo, pregnant, thoracic deformities or injuries 30 = rapid transfer to OR, missing personal data and high patient volume of the ED 18 = lost to follow-up | Not mentioned | Curvilinear | SHA |
POS | Single-center ED | Senior EM residents with at least 2Â years of clinical experience and EMAT US certification | SC | 1-month survival |
Bolvardi 2016 |  > 18 yo, OHCA & EDCA, traumatic and non-traumatic cause, shockable and non-shockable rhythm | Not mentioned | Honda-Japan | n = 159 ROSC |
Iran | Terminal illness, drowning, stroke, severe hypothermia | Any heart activity including the ventricles, galleries, valves, etc. | Curvilinear | Â |
POS | Single-center ED | Physician who was not a member of resuscitation team and had no knowledge of initial rhythm | SC | Â |
Inaba 2015 | OHCA & EDCA, traumatic cause and underwent resuscitative thoracostomy in ED | Just before or concurrent with thoracotomy | SonoSite S-FAST or M-Turbo | n = 180 |
USA | Emergent or urgent thoracotomy in OR, inadequate view (n = 7) | Organized, non-fibrillating contractions | Phased array |  |
POS | Single-center ED | PGY 2–4 EM residents under direct supervision, completed 16-h US course consisting of didactics and hands-on training and minimum 2 weeks of training in PoCUS | SC, PS | SHD |
Cebicci 2014 |  > 18 yo, OHCA & EDCA, traumatic and non-traumatic cause, shockable and non-shockable rhythm | Patient arrival | CHISON 8500 | n = 410 ROSC |
Turkey | No recorded rhythm or US at arrival (n = 73) | Not mentioned | Curvilinear | 24-h survival |
ROS | Single-center ED | 4 EM specialist certified in emergency US and have enough experience | Not mentioned | Â |
Ferrada 2014 | OHCA, traumatic cause and did not survive resuscitation | Pulse check < 10 s | Not mentioned | n = 14 |
USA | US not done (n = 23) | Not mentioned | Not mentioned |  |
ROS | Trauma center | Trained EPs, trauma attending surgeons, and residents in both specialties | SC, PSLA, PSSA, A4C | Â |
Cureton 2012 |  > 18 yo, OHCA, traumatic cause, non-shockable rhythm | Not mentioned | SonoSite MicroMaxx | n = 162 |
USA | US not done (n = 156) | Organized non-fibrillating motion | Curvilinear | SHA |
ROS | University-based urban trauma center | Surgeon or EP with US training under direct supervision of FAST-credentialed EM attending or trauma surgeon | SC | SHD |
Aichinger 2012 | Convenience sampling, > 18 yo, OHCA, non-traumatic cause, shockable and non-shockable rhythm | Rhythm/pulse check and after initial procedures (defibrillation, intubation, vascular access), multiple echoes allowed; CPR had to be continued for at least 15 min after initial echo | SonoSite 180 Plus (portable machine) | n = 42 |
Austria |  < 18 yo, trauma | Any detected motion of the myocardium, ranging from visible VF to coordinated ventricular contractions | Micro-convex | ROSC on ED arrival |
POS | 2 emergency vehicles that are comparable to mobile ICUs on call 24Â h per day | 24 EPs with 2-h course in focused echo | SC | SHD |
Tomruk 2012 | Convenience sampling, > 18 yo, OHCA and EDCA, traumatic and non-traumatic cause, shockable and non-shockable rhythm | Immediate during initial assessment | Chison 600 M | n = 149 ROSC |
Turkey | Terminal illness, drowning, hanging, severe hypothermia | Any detected motion within heart, including atrial, valvular, and/or ventricular motion | Curvilinear | Â |
POS | Single-center ED | EPs with theoretical and hands-on training on cardiac US | SC | Â |
Chardoli 2012 | Convenience sampling, adult, OHCA, traumatic and non-traumatic cause, PEA rhythm | First pulse check < 10 s | Not mentioned | n = 100 ROSC |
Iran | Not mentioned | Not mentioned; cardiac activity finding was not notified to leader to avoid bias in CPR duration | Not mentioned | Â |
RCT | 2 academic EDs | Emergency resident with course to achieve competence in echo for subxiphoid view in 10Â s | SC | Â |
Hayhurst 2011 | Convenience sampling, adult, OHCA, traumatic and non-traumatic cause, shockable and non-shockable rhythm | Rhythm check < 10 s | Not mentioned | n = 49 ROSC |
UK | US done outside cardiac arrest period (n = 6), incomplete data | Not mentioned; US did not contribute to any decisions to stop ALS | Curvilinear, Phased array | SHA |
POS | 2 centers EDs | EPs or specialist trainees with Level 1 competency in emergency US. Extra sessions held for revision of 3 cardiac windows and assessed obtaining adequate picture in 10Â s | SC, PSLA, A4C | SHD |
Tarmey 2011 |  > 18 yo, OHCA & EDCA, traumatic cause, shockable and non-shockable rhythm | Not mentioned | Not mentioned | n = 24 ROSC |
Afghanistan | Declared dead prior to arrival, or arrested only after withdrawal of active management, US not done (n = 28) | Not mentioned | Not mentioned |  |
POS | Military trauma center | Not mentioned | Not mentioned | SHD |
Breitkreutz 2010 | OHCA, non-traumatic cause, non-shockable rhythm | Pulse check < 10 s | Hand-held US (modified Tringa by Esaote) + 3.5–5 MHz probe | n = 88 |
Germany | Not mentioned | Not mentioned | Standard US (SonoSite i-Look 15) + curved array probe | ROSC on ED arrival |
POS | 4 EMS (Emergency Medical Services) | EPs trained in peri-resuscitation echo (FEEL program). EP was specialist in cardiology, IM, surgery, anesthesia, or pediatrics with an additional sub-specialization in prehospital EM | SC, PS, A4C | Â |
Schuster 2009 | OHCA and EDCA, traumatic cause, PEA rhythm | Not mentioned | Philips EnVisor | n = 27 ROSC |
USA | Not mentioned | Organized non-fibrillating contractile activity with decrease in chamber size | Curvilinear, Phased array | Â |
ROS | Level-1 trauma center | Trained senior surgeon or EM resident under direct supervision of FAST-credentialed trauma surgeon or EP | SC, PS | SHD |
Salen 2005 | Convenience sampling, > 16 yo, OHCA and EDCA, non-traumatic cause, non-shockable rhythm | Initial US on presentation and sequential examinations every 3–5 min during carotid pulse checks | Not mentioned | n = 70 ROSC |
USA | Not mentioned | Any detected motion within the heart: atrial, valvular, or ventricular | Curvilinear, Phased array | SHA |
POS | 4 academic EDs | EPs | SC, PSLA | SHD |
Tayal 2003 | OHCA, non-traumatic cause, PEA rhythm | Not mentioned | Shimadzu SDU-400 | n = 20 ROSC |
USA | Not mentioned | Ventricular wall motion | Not mentioned | Â |
POS | Tertiary center ED | Trained EPs with 20-h emergency ultrasound course, followed by continuous quality improvement reviews and direct feedback | SC, PS, A4C | SHD |
Salen 2001 | Convenience sampling, > 18 yo, OHCA, non-traumatic cause, shockable and non-shockable rhythm | Pulse check < 10 s repeated with any change in rhythm | Pie Medical Scanner 200 and GE RT3200 Advantage II | n = 102 |
USA | Not mentioned | Not mentioned | Curvilinear | SHA |
POS | 2 community hospital EDs | EPs, residents and attendings with 4-h trauma US course during which focused cardiac US was taught and practiced on simulator models | SC, A4C | Â |
Blaivas 2001 | Convenience sampling, > 18 yo, OHCA, non-traumatic cause, shockable and non-shockable rhythm | On patient arrival and during pulse check < 10 s | Aloka 2000 | n = 169 |
USA |  < 18 yo, trauma, non-cardiac cause (drug overdose) | Not mentioned | Curvilinear, Phased array | SHA |
POS | Urban community hospital ED | US trained and credentialed EPs (resident and attendings) | SC, PS | Â |