Abstract
Background
Transesophageal echocardiography (TEE) has been proposed as a modality to assess patients
in the setting of cardiac arrest, both during resuscitation care and following return
of spontaneous circulation (ROSC). In this study we aimed to assess the feasibility
and clinical impact of TEE during the emergency department (ED) evaluation during
out-of-hospital cardiac arrest (OHCA).
Materials and methods
We conducted a prospective observational study consisting of a convenience sample
of adult patients presenting to the ED of an urban university medical center with
non-traumatic OHCA. TEE was performed by emergency physicians following intubation.
Images and clinical data were analyzed. TEE was used intra-arrest in order to assist
in diagnosis, assess cardiac activity and determine CPR quality by assessing area
of maximal compression (AMC), using a 4 view protocol.
Results
A total of 33 OHCA patients were enrolled over a one-year period, 21 patients (64%)
presented with ongoing CPR and 12 (36%) presented with ROSC. The 4-view protocol was
completed in 100% of the cases, with an average time from ED arrival to TEE of 12 min
(min 3 max 30 SD 8.16). Fine ventricular fibrillation (VF) was recognized in 4 (12%)
cases thought to be in asystole, leading to defibrillation, and 2 cases of pseudo-PEA
were identified. Right ventricular (RV) dilation, was seen in 12 (57%) intraarrest
cases. Intra-cardiac thrombus was found in one case, leading to thrombolysis. The
AMC was identified over the aortic root or LVOT in 53% of cases. TEE was found to
have diagnostic, therapeutic or prognostic clinical impact in 32 of the 33 cases (97%).
Conclusions
TEE is feasible and clinically impactful during OHCA management. Resuscitative TEE
may allow for characterization of cardiac activity, including identification of pseudo-PEA
and fine VF, determination of reversible pathology, and optimization of CPR quality.
Keywords
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Article info
Publication history
Published online: February 16, 2019
Accepted:
February 7,
2019
Received in revised form:
January 8,
2019
Received:
October 8,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
