Hocus POCUS

 

🫀 Using POCUS to Guide Cardiac Arrest Management: Game-Changer or Hype?

We’ve all been there: a high-stakes cardiac arrest, compressions flying, epi flowing, and the whole team working in sync. But how do we know if we’re making progress? That’s where point-of-care ultrasound (POCUS) comes in—a quick, portable, real-time look into the heart of the matter. Literally.

In the last five years, there's been a wave of new research showing just how powerful (and practical) POCUS can be in cardiac arrest. Let's dig into what we know—and what we still need to figure out.

💡 Why POCUS is Getting So Much Attention

Cardiac arrest algorithms are great—ACLS is a life-saving standard—but they don’t always tell us what’s really going on. POCUS fills in the gaps by helping answer questions like:

  • Is the heart moving at all?

  • Is there tamponade, massive PE, or a collapsed ventricle?

  • Should we keep going—or is it time to call it?

And crucially: it can do all this without adding too much interruption… if used well.

🔍 Cardiac Motion = Hope

One of the biggest things POCUS brings to the table is the ability to see cardiac activity (or lack thereof). And that matters—a lot.

A 2024 review found that when you see any cardiac motion on POCUS during arrest, the chances of return of spontaneous circulation (ROSC) shoot up. One study saw ROSC in nearly 30% of patients with motion vs. only 7% without it.

On the flip side, standstill—no visible motion—almost always means a poor outcome. In one meta-analysis, patients with cardiac standstill had a >90% chance of not surviving to hospital admission.

👉 Bottom line? Cardiac motion buys more time. Teams are more likely to keep going, give more meds, and try more interventions when they see movement.

🕵️‍♂️ Spotting the Reversible Causes (H’s and T’s)

POCUS shines when it comes to identifying the "fixable stuff":

  • Tamponade? See that pericardial effusion.

  • Massive PE? Right ventricle might be dilated or hypokinetic.

  • Tension pneumothorax? No lung sliding.

  • Hypovolemia? Flat IVC and barely-there cardiac filling.

In some cases, spotting these can literally change the direction of the code—there are even reports of POCUS-guided diagnosis of PE leading to ECMO and full neurologic recovery.

⏱️ What About Interrupting CPR?

A valid concern: doesn’t ultrasound slow things down?

Good news: modern protocols (like CASA and PECA) are designed to minimize that risk. Teams practice getting the probe into place ahead of the pulse check and limiting scans to 10 seconds or less. When done right, POCUS doesn't have to interrupt high-quality compressions.

A 2023 study showed teams were able to keep pause time under 10 seconds in 95% of cases when using structured protocols.

So, no excuses—POCUS doesn’t need to break your rhythm.

🚑 Can EMS Use It Too?

Surprisingly, yes—and pretty effectively.

Recent EMS studies show that trained paramedics can acquire and interpret cardiac ultrasound images during out-of-hospital cardiac arrests. One pilot study found that 88% of interpretations were accurate, and POCUS findings influenced care in nearly a third of cases.

It’s not just an ED toy anymore.

⚠️ What to Keep in Mind

POCUS is powerful, but not perfect:

  • It’s still mostly based on observational studies—no huge RCTs yet.

  • Image quality and interpretation can vary (a lot).

  • It shouldn’t override clinical judgment or ACLS protocol.

  • And it’s not (yet) recommended by AHA guidelines as a standard part of resuscitation.

Also: be careful not to let the probe become a distraction or cause prolonged pauses. The data’s clear—compressions still rule.

🔮 What’s Next?

  • Serial ultrasounds: Looking at multiple timepoints during arrest may help confirm when efforts are truly futile (e.g., standstill lasting more than 6–10 minutes).

  • Transesophageal echo (TEE): A continuous view without stopping compressions? Yes please. But this is mostly in-hospital and needs more training.

  • AI-assisted POCUS: Real-time feedback and auto-interpretation tools are already in development—so even non-experts might soon get expert-level help.

Final Thoughts

POCUS during cardiac arrest isn’t just cool tech—it’s a practical tool that can help guide care in real time, especially when you're facing a tough decision. It’s not a magic bullet, and it can’t replace good CPR and clinical thinking. But used wisely, it adds real value.

So next time you're in a code and have the probe ready, don't hesitate to take a peek.


#bloggingfromthebay

— CrashCart Kelly

References

  1. Aichinger G, et al. Early point-of-care echocardiography as a predictive factor for absence of ROSC in out‑of‑hospital cardiac arrests. Resuscitation. 2024.

  2. Kim DY, et al. Serial POCUS during CPR and prognostication of resuscitation outcomes. 2023.

  3. Mousavi A, et al. The role of POCUS in clinical outcomes during cardiac arrest: a systematic review. Ultrasound J. 2024.

  4. Heringlake M, et al. Prognostic accuracy of POCUS in pulseless electrical activity: a meta-analysis. 2025.

  5. Becker T, et al. Initial cardiac activity and arrest outcomes: a prospective cohort. Turk J Emerg Med. 2023.

  6. Gaspari F, et al. REASON study: non-shockable cardiac arrest and ultrasound outcomes. 2022.

  7. Hojnowski-Diaz M, et al. POCUS in cardiac arrest: systematic review. Cardiovasc Ultrasound. 2020.

  8. JEMS. POCUS in prehospital cardiac arrest: paramedic protocols and performance. 2023.

  9. AHA Guidelines 2020/2024 Update. Recommendations on POCUS during CPR.

Comments

Post a Comment

Popular posts from this blog

Welcome!

  🩺 Welcome to The Medic Minute Your Source for Emergency Medicine Practice Updates By a CEN Who Lives It Hi there, and welcome to the blog! I'm a Certified Emergency Nurse (CEN) with years of frontline experience in the controlled chaos we call the Emergency Department. If you’ve ever triaged a patient, started compressions in seconds flat, or had to make a clinical decision with limited information and even less time — you’re in the right place. I started this blog with a simple goal:  to keep emergency medicine professionals sharp, current, and connected . Guidelines change. Evidence evolves. And as much as we live in the thick of it, it’s not always easy to carve out time to stay updated. That’s where this space comes in. Here’s what you can expect: 🔄  Practice Guideline Updates  — from trauma protocols to airway algorithms. 🧠  Clinical Pearls & Pitfalls  — quick takeaways that could make or break a shift. 🛠  Real-World Application  — ...
Read more

Blood, Belmonts, and the Back of the Rig: A Guide to Mass Transfusion

“Activate MTP!”  That phrase has become one of the most defining moments of modern emergency and trauma nursing. We’ve come a long way from the days of blindly hanging fluids and praying for a stable pressure. Today, we have coordinated  massive transfusion protocols (MTPs) ,  Belmont rapid infusers , and—thanks to some bold EMS systems— prehospital blood products  already dripping before the stretcher even hits the door. But with new tools and protocols comes new responsibility—and a need to stay sharp on the  why , not just the  how . 🩸 What  Is  a Massive Transfusion Protocol? Massive transfusion  is usually defined as: >10 units of PRBCs within 24 hours , or >4 units in 1 hour with ongoing need , or Replacement of >50% of blood volume in 3 hours But practically? If your trauma team’s activating MTP, you know you're in the thick of it. MTPs are designed to: Restore  oxygen-carrying capacity  and  coagulation functi...
Read more

Poking Holes in Your Practice Methods

  🚑 Prehospital Needle Decompression: What EMS Providers Need to Know in 2025 By CrashCart Kelly Tension pneumothorax is a killer. Without quick intervention, it can rapidly progress to obstructive shock and cardiac arrest. In the field,  needle decompression  remains one of the most critical—and time-sensitive—skills an EMS provider can perform. But like everything in medicine, our approach to this procedure has evolved. This post breaks down the  latest, evidence-based guidance  on how to perform needle decompression  right —from site selection to needle length, and when you should (and shouldn’t) do it. 🎯 When Should You Decompress? Needle decompression isn’t for every trauma patient with low sats. According to recent studies, overuse leads to  iatrogenic pneumothorax, vascular injury, and poor outcomes . ✅ Perform needle decompression  only  if your patient has: Chest trauma or barotrauma  and Severe respiratory distress or hypoxia...
Read more