Background <p>The prognosis for pulseless electrical activity (PEA) is typically poor; however, patients with cardiac activity observed on point-of-care ultrasound (POCUS) tend to have better outcomes compared to those without. This systematic review and meta-analysis were conducted to assess the prognostic accuracy of cardiac activity detected by POCUS in predicting resuscitation outcomes in patients experiencing PEA.</p> Methods <p>A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify relevant studies. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio, and the area under the summary receiver operating characteristic curve (SROC) were calculated using the bivariate model.</p> Results <p>Eighteen studies comprising 1202 patients were included in the meta-analysis. Cardiac activity observed on POCUS demonstrated a pooled sensitivity of 0.86 (95% CI 0.67–0.95) and specificity of 0.64 (95% CI 0.51–0.75) for predicting return of spontaneous circulation, a pooled sensitivity of 0.89 (95% CI 0.80–0.94) and specificity of 0.73 (95% CI 0.63–0.81) for survival to admission (SHA), and a pooled sensitivity of 0.79 (95% CI 0.58–0.91) and specificity of 0.58 (95% CI 0.47–0.68) for survival to discharge. The highest area under the SROC, 0.89 (95% CI 0.86–0.92), was observed for SHA.</p> Conclusions <p>Our study suggests that POCUS may serve as a vital component of a multimodal approach for early termination of resuscitation.</p>