Reversible Causes of Cardiac Arrest by Sonological Transthoracic AssessmenT (ReSTAT) in Predicting Reversible Cardiac Arrest Scenarios: A Retrospective Observational Study

Background: Cardio-pulmonary resuscitation has taken a front seat in the recent past. Guidelines of the Indian Resuscitation Council (IRC) focused on reversible causes of cardiac arrest. However, the delay in achieving the return of spontaneous circulation (ROSC) has worse outcomes, impacting the Glasgow outcome score (GOS). The use of point-of-care ultrasonography helps clinicians in diagnosis and guides toward cause-specific management. Objective: To identify the sonologically detected reversible causes of cardiac arrest by point of care ultrasonography. Materials: A retrospective, single-centred, observational cohort study was conducted in a tertiary-level teaching hospital in eastern India. Adult patients who sustained in-hospital cardiac arrest (IHCA) were included in the study. Point of care ultrasonography protocol was designed, validated, and named as ReSTAT ( R eversible causes of cardiac arrest by S onological T ransthoracic A ssesmen T) . ReSTAT was performed at bilateral anterior and lateral lung zones along with a subcostal view of heart, during CPR without interrupting the CPR as per the IRC guidelines. The causes of cardiac arrest among survivors were reviewed from ICU records and ultrasound register. Results: A total of 126 IHCA were attended from December 2022 to November 2023, 60 cases were excluded, 66 patients were included for final analysis, out of which 14 survived and discharged from the hospital. Reversible causes in the survivors were found in 8 patients and were treated (haemothorax-3(21%), pneumothorax-2(14%), and cardiac tamponade-1 (7%) hyperkalaemia-2 (14%)). Ultrasonography was helpful in 6 of the patients that survived. ROSC time and Glasgow outcome scores were less in this subset of patients. Conclusion: ReSTAT is a harbinger of reversible cardiac arrest scenarios.