The Role of Point-of-care Ultrasound in Cardiac Arrest; A Narrative Review
Archives of Academic Emergency Medicine,
Vol. 13 No. 1 (2025),
6 September 2025
,
Page e68
https://doi.org/10.22037/aaemj.v13i1.2748
Abstract
Cardiac arrest is a life-threatening condition with a high mortality rate, necessitating prompt recognition and treatment of reversible causes to enhance patient survival. Point-of-care ultrasound (POCUS) has emerged as a useful tool that contributes to optimizing resuscitative efforts. This imaging modality offers real-time visualization that assists in detecting reversible causes such as cardiac tamponade, pulmonary embolism, tension pneumothorax and hypovolemia. This review aims to explore the expanding role of ultrasound in the assessment and management of cardiac arrest, emphasizing its utility in identifying cardiac arrest, differentiating between true pulseless electrical activity (PEA) and pseudo-PEA, detecting the reversible causes, guiding clinical decision-making, and potentially predicting outcomes. A comprehensive literature search was performed using the PubMed database from inception to April 2025. Articles were selected based on their relevance to the role and applications of POCUS in cardiac arrest.
- POCUS
- cardiac arrest
- reversible causes
- Point-of-care systems
- ultrasonography
- heart arrest
- etiology
- prognosis
How to Cite
References
Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation. 2022;145(8):e153-e639.
Empana JP, Lerner I, Valentin E, Folke F, Bottiger B, Gislason G, et al. Incidence of Sudden Cardiac Death in the European Union. J Am Coll Cardiol. 2022;79(18):1818-27.
Grasner JT, Herlitz J, Tjelmeland IBM, Wnent J, Masterson S, Lilja G, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021;161:61-79.
Soar J, Bottiger BW, Carli P, Couper K, Deakin CD, Djarv T, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021;161:115-51.
Nicola R, Dogra V. Ultrasound: the triage tool in the emergency department: using ultrasound first. Br J Radiol. 2016;89(1061):20150790.
Eberle B, Dick WF, Schneider T, Wisser G, Doetsch S, Tzanova I. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation. 1996;33(2):107-16.
Simard RD, Unger AG, Betz M, Wu A, Chenkin J. The POCUS Pulse Check: A Case Series on a Novel Method for Determining the Presence of a Pulse Using Point-of-Care Ultrasound. J Emerg Med. 2019;56(6):674-9.
Cohen AL, T.; Becker, L.; Rolston, D.; Nelson, M.; Owens, C.; Gordon M. Time for a Change: Use of Doppler Ultrasound for Pulse Checks in Cardiac Arrest Patients. Circulation. 2020;142.
Schwartz BE, Gandhi P, Najafali D, Gregory MM, Jacob N, Helberg T, et al. Manual Palpation vs. Femoral Arterial Doppler Ultrasound for Comparison of Pulse Check Time During Cardiopulmonary Resuscitation in the Emergency Department: A Pilot Study. J Emerg Med. 2021;61(6):720-30.
Betz SB, H.; Rettich, F.; Kreutz, J.; Ploeger, B.; Jaenig, C.; Grosch, S.; Meggiolaro, K.; Jerrentrup, A.; Schmidbauer, W.; Schieffer, B.; Grueb, T. Point-of-Care Ultrasound Pulse Checks During Cardiopulmonary Resuscitation on a Patient Simulator (PUPRAS). Diagnostics. 2025;15(7).
Hussein L, Rehman MA, Sajid R, Annajjar F, Al-Janabi T. Bedside ultrasound in cardiac standstill: a clinical review. Ultrasound J. 2019;11(1):35.
Rabjohns J, Quan T, Boniface K, Pourmand A. Pseudo-pulseless electrical activity in the emergency department, an evidence based approach. Am J Emerg Med. 2020;38(2):371-5.
Devia Jaramillo G, Navarrete Aldana N, Rojas Ortiz Z. Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia. Int J Emerg Med. 2020;13(1):62.
Amaya SC, Langsam A. Ultrasound detection of ventricular fibrillation disguised as asystole. Ann Emerg Med. 1999;33(3):344-6.
Wong A, Vignon P, Robba C. How I use ultrasound in cardiac arrest. Intensive Care Med. 2023;49(12):1531-4.
Lichtenstein D, Malbrain ML. Critical care ultrasound in cardiac arrest. Technological requirements for performing the SESAME-protocol--a holistic approach. Anaesthesiol Intensive Ther. 2015;47(5):471-81.
Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, Marshall J. C.A.U.S.E.: Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation. 2008;76(2):198-206.
Gardner KF, Clattenburg EJ, Wroe P, Singh A, Mantuani D, Nagdev A. The Cardiac Arrest Sonographic Assessment (CASA) exam - A standardized approach to the use of ultrasound in PEA. Am J Emerg Med. 2018;36(4):729-31.
Testa A, Cibinel GA, Portale G, Forte P, Giannuzzi R, Pignataro G, et al. The proposal of an integrated ultrasonographic approach into the ALS algorithm for cardiac arrest: the PEA protocol. Eur Rev Med Pharmacol Sci. 2010;14(2):77-88.
Bughrara N, Herrick SL, Leimer E, Sirigaddi K, Roberts K, Pustavoitau A. Focused Cardiac Ultrasound and the Periresuscitative Period: A Case Series of Resident-Performed Echocardiographic Assessment Using Subcostal-Only View in Advanced Life Support. A A Pract. 2020;14(10):e01278.
Mauriello A, Marrazzo G, Del Vecchio GE, Ascrizzi A, Roma AS, Correra A, et al. Echocardiography in Cardiac Arrest: Incremental Diagnostic and Prognostic Role during Resuscitation Care. Diagnostics (Basel). 2024;14(18).
K A, S B, Govindarajalou R, Saya GK, Tp E, Rajendran G. Comparing Sensitivity and Specificity of Ultrasonography With Chest Radiography in Detecting Pneumothorax and Hemothorax in Chest Trauma Patients: A Cross-Sectional Diagnostic Study. Cureus. 2023;15(8):e44456.
Bhoil R, Ahluwalia A, Chopra R, Surya M, Bhoil S. Signs and lines in lung ultrasound. J Ultrason. 2021;21(86):e225-e33.
Kurkciyan I, Meron G, Sterz F, Janata K, Domanovits H, Holzer M, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med. 2000;160(10):1529-35.
Avila-Reyes D, Acevedo-Cardona AO, Gomez-Gonzalez JF, Echeverry-Piedrahita DR, Aguirre-Florez M, Giraldo-Diaconeasa A. Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article. Ultrasound J. 2021;13(1):46.
Gottlieb M, Alerhand S. Managing Cardiac Arrest Using Ultrasound. Ann Emerg Med. 2023;81(5):532-42.
Stolz L, Situ-LaCasse E, Acuna J, Thompson M, Hawbaker N, Valenzuela J, et al. What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance? World J Emerg Med. 2021;12(3):169-73.
Dewar ZE, Ko S, Rogers C, Oropallo A, Augustine A, Pamula A, et al. Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study. Ultrasound J. 2022;14(1):23.
Gerlando F, Scaccaglia D, Artioli G, Sarli L, Romano R. Intraosseus access vs ecoguided peripherical venous access in emergency and urgency: a systematic review. Acta Biomed. 2021;92(S2):e2021334.
Gottlieb M, O'Brien JR, Ferrigno N, Sundaram T. Point-of-care ultrasound for airway management in the emergency and critical care setting. Clin Exp Emerg Med. 2024;11(1):22-32.
Bhende MS, Thompson AE. Evaluation of an end-tidal CO2 detector during pediatric cardiopulmonary resuscitation. Pediatrics. 1995;95(3):395-9.
Anderson EB, C. Bedside Transtracheal Ultrasound Accurately Confirms Endotracheal Tube Placement. NEJM Journal Watch. 2015.
Bolvardi E, Pouryaghobi SM, Farzane R, Chokan NM, Ahmadi K, Reihani H. The Prognostic Value of Using Ultrasonography in Cardiac Resuscitation of Patients with Cardiac Arrest. Int J Biomed Sci. 2016;12(3):110-4.
Eckstein M, Hatch L, Malleck J, McClung C, Henderson SO. End-tidal CO2 as a predictor of survival in out-of-hospital cardiac arrest. Prehosp Disaster Med. 2011;26(3):148-50.
Atkinson PR, Beckett N, French J, Banerjee A, Fraser J, Lewis D. Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. Cureus. 2019;11(4):e4456.
Gaspari R, Weekes A, Adhikari S, Noble VE, Nomura JT, Theodoro D, et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation. 2016;109:33-9.
Lalande E, Burwash-Brennan T, Burns K, Atkinson P, Lambert M, Jarman B, et al. Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHoC investigators. Resuscitation. 2019;139:159-66.
Long B, Alerhand S, Maliel K, Koyfman A. Echocardiography in cardiac arrest: An emergency medicine review. Am J Emerg Med. 2018;36(3):488-93.
Huis In 't Veld MA, Allison MG, Bostick DS, Fisher KR, Goloubeva OG, Witting MD, et al. Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation. 2017;119:95-8.
Clattenburg EJ, Wroe P, Brown S, Gardner K, Losonczy L, Singh A, et al. Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: A prospective cohort study. Resuscitation. 2018;122:65-8.
Reynolds JC, Nicholson T, O'Neil B, Drennan IR, Issa M, Welsford M, et al. Diagnostic test accuracy of point-of-care ultrasound during cardiopulmonary resuscitation to indicate the etiology of cardiac arrest: A systematic review. Resuscitation. 2022;172:54-63.
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