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Characteristics of high-echoic objects in the hepatic vessels of patients with cardiopulmonary arrest: a prospective cohort study
  1. Shinju Arata1,
  2. Junichi Suzuki1,
  3. Yoshihiro Moriwaki1,
  4. Noriyuki Suzuki1,
  5. Masayuki Iwashita1,
  6. Mitsugi Sugiyama1,
  7. Satoshi Morita2
  1. 1Critical Care and Emergency Centre, Yokohama City University School of Medicine, Yokohama, Japan
  2. 2Department of Biostatistics and Epidemiology, Yokohama City University School of Medicine, Yokohama, Japan
  1. Correspondence to Dr Shinju Arata, Critical Care and Emergency Centre, Yokohama City University School of Medicine, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; s_arata{at}


Background High-echoic objects in the hepatic vessels of patients with cardiopulmonary arrest (CPA) are frequently detected by ultrasonography.

Objective To demonstrate this phenomenon and clarify its clinical characteristics.

Methods In a tertiary care academic medical centre, 203 CPA patients were evaluated by ultrasonography. CT determined the origin and location of high-echoic objects detected in the liver. The frequency and characteristics of this phenomenon were investigated. The background, laboratory data and survival rate were compared between patients with and without high-echoic objects.

Results High-echoic objects were seen in 73 (36.0%) patients and could clearly be detected in the hepatic veins of 41 (56.2%) patients. CT confirmed that these were gas in 27 of 53 patients, and were clearly visible in the hepatic veins in 12 (44.4%) patients. Hepatic portal venous gas was not identified. Compared to patients without high-echoic objects, witnessed arrest (p<0.001), bystander cardiopulmonary resuscitation (p=0.005), ventricular fibrillation or pulseless electrical activity (p=0.012) and return of spontaneous circulation (p=0.018) were significantly less frequent in patients with high-echoic objects. These patients had a lower incidence of survival to discharge (1.4% vs 7.7%, p=0.100). Multivariate analysis showed that absence of high-echoic objects was a marginally significant factor in association with return of spontaneous circulation (p=0.052).

Conclusions High-echoic objects were often observed on ultrasonography in CPA patients; these objects were considered hepatic venous gas. The presence of high-echoic objects may be a poor prognostic sign in patients with CPA.

  • Hepatic venous gas
  • cardiopulmonary arrest
  • cardiopulmonary resuscitation
  • ultra-sonography
  • hepatic portal venous gas
  • imaging

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Yokohama City University School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.