University of Massachusetts, Worcester
The goal of this study is to describe the population of patients presenting after out of hospital cardiac arrest with occult perfusion, defined as a patient without a palpable pulse but with some evidence of pulsatile arterial flow. The main questions it aims to answer are: * To measure the prevalence of patients of patients presenting to the emergency department after out of hospital cardiac arrest with occult perfusion * To measure the association between occult perfusion and survival * Compare survival between patients with occult perfusion that were treated as pulseless by ACLS interventions vs those treated as hypotensive Researchers will describe the percentage of out-of-hospital cardiac arrest presenting to the emergency department without a pulse but with occult perfusion. Researchers will also compare survival endpoints (ROSC, Survival to hospital Admission, and Survival to Hospital Discharge) in pulseless patients with occult perfusion treated with ACLS interventions only and pulseless patients with occult perfusion treated as if they had pulsatile arterial flow. Participants will undergo resuscitation based on decisions by the clinical team who incorporate echo and/or vascular ultrasound during the first three rounds of CPR. The resuscitation will continue until the patient demonstrates return of spontaneous circulation or until the clinical team halts resuscitative efforts due to futility.
This is a multi-center, prospective, observational trial involving sites across the United States and Canada. Patients having suffered an out of hospital cardiac arrest will be enrolled through the emergency department either presenting in cardiac arrest with ongoing CPR or having been resuscitated en-route but re-arresting shortly after arriving in the emergency department. Patients will undergo any echocardiography or vascular ultrasound during the resuscitation at the discretion of the clinical team and based on institutional protocols. The clinical team will be unblinded to any aspect of…
Inclusion Criteria: * Patients presenting following out-of-hospital atraumatic cardiac arrest Exclusion Criteria: * Resuscitation ended due to end-of-life decisions * Documented allergy to ultrasound gel * Technical malfunction of ultrasound machine during imaging that prevents use * Ultrasound machine unable to record images * Cardiac Ultrasound not performed during first, second or third pause in CPR AND vascular Ultrasound not performed during first, second or third pause in CPR