Seeing the Stillness – Cardiac Standstill Predicts ROSC

Written by Jonathan Brewer

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Cardiac standstill on transthoracic echocardiography is a strong predictor of failing to achieve return of spontaneous circulation (ROSC). However, while it offers high diagnostic accuracy, emergency physicians should use it as one prognostic marker among others rather than a sole reason to terminate efforts.

The predictive power of standstill 
This systematic review and meta-analysis of 24 studies involving 3,684 patients evaluated the accuracy of cardiac standstill (defined as the complete absence of spontaneous myocardial or valvular motion) in predicting the absence of ROSC across both traumatic and nontraumatic arrests. The pooled data revealed a sensitivity of 85.6% and a specificity of 79.0% for predicting the absence of ROSC, indicating good diagnostic accuracy. The positive likelihood ratio is 2.69, which means standstill increases odds of persistent arrest 2.7-fold over the pretest odds. Notably, subgroup analyses demonstrated that this predictive value remained consistent regardless of whether the arrest was medical or traumatic in origin. Furthermore, the level of sonographer training did not significantly impact the diagnostic performance, suggesting the findings are robust across various clinical settings.

How does this change my practice? 
Cardiac standstill on ultrasound is a valuable predictor of futility. However, because it is not 100% specific (and sometimes difficult to judge), it’s important to remember that ultrasound is a diagnostic tool that should be combined with ETCO2 and clinical context rather than using it as an isolated “stop” signal.

Source
Does Cardiac Standstill on Early Focused Transthoracic Echocardiography Predict Absence of Return of Spontaneous Circulation in Cardiac Arrest? A Systematic Review and Meta-Analysis. J Emerg Med. 2026 Mar;82:9-44. doi: 10.1016/j.jemermed.2025.12.018. Epub 2025 Dec 15. PMID: 41610792.