The role of ultrasound in the management of patients experiencing cardiac arrest is primarily to provide rapid, real-time diagnostic and prognostic information that guides resuscitative efforts without causing harmful interruptions to cardiopulmonary resuscitation (CPR).
Point-of-care ultrasound (POCUS) is utilized during cardiac arrest to identify reversible causes such as cardiac tamponade, tension pneumothorax, and massive pulmonary embolism, which are critical to address promptly for improving outcomes Anto et al. 2026 Anto et al. 2026. Ultrasound helps distinguish true pulseless electrical activity (PEA) from pseudo-PEA by detecting cardiac motion absent on palpation but present on imaging, thereby affecting management decisions and prognostication Anto et al. 2026 Anto et al. 2026 Kongkatong et al. 2023.
Transesophageal echocardiography (TEE), as an advanced form of ultrasound during cardiac arrest, overcomes limitations of transthoracic echocardiography by providing continuous, high-quality cardiac imaging without interfering with chest compressions, enabling real-time feedback on chest compression quality, rhythm characterization, and reversible cause diagnosis SmPC Bupivacaine Kongkatong et al. 2023 Riendeau Beaulac et al. 2023.
POCUS performed within the 10-second rhythm and pulse check window maximizes diagnostic utility while minimizing CPR interruptions through structured protocols such as the Cardiac Arrest Sonographic Assessment (CASA) protocol Anto et al. 2026 Anto et al. 2026 Lin et al. 2024. These protocols prioritize rapid, focused assessments (e.g., subxiphoid for tamponade, parasternal long axis for ventricular function, lung scanning for pneumothorax) sequentially across CPR cycles Anto et al. 2026 Anto et al. 2026.
Ultrasound can also identify return of spontaneous circulation (ROSC) earlier than manual pulse checks by detecting coordinated cardiac contractions or carotid artery pulsatility, thus potentially reducing pauses and improving situational awareness during resuscitation Anto et al. 2026 Anto et al. 2026.
Despite its significant diagnostic and monitoring advantages, current evidence indicates that the use of POCUS during cardiac arrest, when performed improperly or causing prolonged pauses, does not improve outcomes and should not be used alone to guide termination of resuscitation efforts Anto et al. 2026 Anto et al. 2026. Adequate training, team coordination, timing, and interpretation after resumption of compressions are essential to avoid misuse Anto et al. 2026 Anto et al. 2026 Lin et al. 2024.
In summary, ultrasound in cardiac arrest management serves as a rapid diagnostic, monitoring, and procedural guidance tool that can direct therapy (e.g., pericardiocentesis, thrombolysis) and improve resuscitation quality when integrated carefully into advanced life support algorithms without prolonging CPR interruptions SmPC Bupivacaine Riendeau Beaulac et al. 2023 Kongkatong et al. 2023 Lin et al. 2024 Anto et al. 2026.
Key References
- NICE CKS: Cardiac arrest - out of hospital care
- NICE NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management
- NICE CKS: Blackouts and syncope
- SmPC: Bupivacaine 5mg/ml Solution for Injection
- SmPC: Bupivacaine 2.5mg/ml Solution for Injection
- (Riendeau Beaulac et al., 2023): Transesophageal Echocardiography in Patients in Cardiac Arrest: The Heart and Beyond.
- (Kongkatong et al., 2023): Focused Ultrasonography in Cardiac Arrest.
- (Lin et al., 2024): Resuscitative Ultrasound and Protocols.
- (Anto et al., 2026): Point-of-care-ultrasound in cardiac arrest: a useful tool for resuscitation.
- (Khalid et al., N/A): Atypical Posterior Myocardial Infarction With Minimal Symptoms: Diagnostic Impact of Point-of-Care Ultrasound
- (Millington et al., 2026): Ten Influential Point-of-Care Ultrasound Papers: 2025 in Review.