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Abstract

Objective: This study aimed to evaluate the utility of Cardiac Point-of-Care Ultrasound (POCUS) in enhancing the accuracy and timeliness of death declaration in pediatric patients.
Methodology: An observational study was conducted in the Pediatric Intensive Care Unit (PICU) of the Sindh Institute of Child Health and Neonatology from September 2023 to April 2024. Pediatric patients aged 1 month to 12 years were included if they were considered at the end of life based on clinical criteria. Traditional death declaration was determined by the absence of breathing, pulse, heart sounds, response to painful stimuli, fixed dilated pupils, and a flatline on electrocardiogram (ECG). To avoid bias, ECG and clinical assessments were performed simultaneously before conducting cardiac POCUS. A subcostal view of the heart was obtained, and a 1-minute video recording was taken to confirm the absence of cardiac activity. The time from ECG flatline to the confirmation of akinetic cardiac activity on POCUS was recorded for each patient.
Results: Among 1,878 PICU admissions, the mortality rate was 11.7% (220 deaths), of which 60 pediatric patients were included in the study. The median age was 12 months (IQR: 5–23 months), with a male-to-female ratio of 1:1. The two leading causes of death were infectious (30%) and cardiac (23.3%) etiologies. Cardiac POCUS confirmed akinetic cardiac activity in 100% of cases, validating its role as an adjunct in death declaration. The median time from ECG flatline to POCUS-confirmed cardiac standstill was 7.5 minutes (range: 0–44 minutes). However, the variability in time to confirmation suggests that factors such as body habitus, prior inotropic support, and underlying pathology may influence results.
Conclusion: Cardiac POCUS was found to be a reliable adjunct to traditional clinical assessments for pediatric death declaration, offering real-time confirmation of cardiac standstill. However, its accuracy is operator-dependent, highlighting the need for standardized training protocols to minimize variability. Further multicenter studies are recommended to validate its role in clinical practice.