This is a multi-center, prospective, observational trial involving sites across the
United States and Canada. Patients will be enrolled through the emergency department
either presenting in cardiac arrest, or going into cardiac arrest while in the emergency
department after having arrested out of hospital. Advanced Cardiac Life Support (ACLS)
protocols and institutional policies for resuscitation will be followed, as is the
current standard of care. A patient encounter will conclude upon halting of
cardiopulmonary resuscitation. Patient outcome will be evaluated by chart review or
follow-up.
Programs involved in this study must have already integrated echocardiography into
Cardiac Arrest clinically and have established procedures for how imaging is performed in
the context of CPR. Echocardiography will not hinder or impair resuscitative efforts in
any way, including halting CPR or prolonging pauses in CPR. Sonographic images will be
obtained during designated pauses in chest compressions, as is routine care, during CPR
for pulse checks, rhythm checks, and necessary resuscitative procedures.
Echocardiography will be performed as appropriate to obtain diagnostic information for
each particular patient during resuscitative efforts. Recording of the image loops will
be performed during image acquisition according to standard technology availability and
clinical protocols at each site. To facilitate image acquisition, the ultrasound probe
may be placed in the epigastrium or parasternal region during CPR with the heart centered
in the field of view, if it will not interfere with ongoing resuscitation. Recording of
the images can begin immediately upon pauses of CPR using whatever means are available at
the site. Sonographic images will be obtained by competent personnel with experience in
bedside cardiac ultrasound. This information will be made available to the physician
taking care of the patient.
Continuous ECG tracings are displayed during cardiac arrest, and for the purpose of this
study recordings of these ECG tracings will need to be digitally recorded. These digital
ECG 'rhythm strips" will be matched with contemporaneous recordings of the ultrasound
images of the heart.
Subject data, with identifiers removed, will be uploaded into the REDcap web-based
database. Data will be obtained from initial patient encounter, patient records, and EMS
records when available.
Contemporaneous digital recordings of ultrasound images and ECG rhythm strips blinded to
patient identifiers will be included in a centralized database. Echocardiographic images
will be reviewed and interpreted by the central coordinating site blinded to patient
information. ECG images will be reviewed and interpreted by the central coordinating site
blinded to patient information.
Patient cohorts will be compared for the electrical activity by ECG and the myocardial
activity by echo.