@article {Arata213, author = {Shinju Arata and Junichi Suzuki and Yoshihiro Moriwaki and Noriyuki Suzuki and Masayuki Iwashita and Mitsugi Sugiyama and Satoshi Morita}, title = {Characteristics of high-echoic objects in the hepatic vessels of patients with cardiopulmonary arrest: a prospective cohort study}, volume = {29}, number = {3}, pages = {213--218}, year = {2012}, doi = {10.1136/emj.2010.104117}, publisher = {British Association for Accident and Emergency Medicine}, abstract = {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.}, issn = {1472-0205}, URL = {https://emj.bmj.com/content/29/3/213}, eprint = {https://emj.bmj.com/content/29/3/213.full.pdf}, journal = {Emergency Medicine Journal} }