R.E.B.E.L.EM - September 18, 2017
"Clinical Question: How much variability exists in the interpretation of cardiac standstill on POCUS amongst physicians? (
Article: Hu K et al. Variability in Interpretation of Cardiac Standstill Among Physician Sonographers. Ann Emerg Med 2017. PMID: 28870394)
Authors Conclusions: “According to the results of our study, there appears to be considerable variability in interpretation of cardiac standstill among physician sonographers. Consensus definitions of cardiac activity and standstill would improve the quality of cardiac arrest ultrasonographic research and standardize the use of this technology at the bedside.”
Our Conclusions: We agree with the authors that this study, though limited by it’s methodology and convenience sample, demonstrates significant disagreement between providers as to the interpretation of cardiac standstill on POCUS.
Potential to Impact Current Practice: This study cannot be used to impact clinical practice but should cause some pause for thought for providers who are currently using POCUS in cardiac arrest as part of their protocol for termination based on cardiac standstill.
Bottom Line: The use of POCUS to declare death and stop resuscitation is predicated on a clear ability to establish the presence of cardiac standstill. The low level of agreement of providers likely reflects the absence of a single definition of standstill as well as calls for increased training and assessment. A unified definition of standstill would be extremely helpful not only in future research but in cardiac arrest care as well."