Transesophageal Echocardiography During Cardiac Arrest

Transthoracic echocardiography (TTE) has been endorsed by international guidelines as a potentially useful diagnostic modality for the evaluation of patients in cardiac arrest.1,2 Echocardiography can identify organized cardiac activity vs. standstill, predict the likelihood of survival,3–5 and may be used to establish the cause of the arrest and guide treatment, such as in the case of pericardial tamponade or massive pulmonary embolus. However, the process of TTE image acquisition has been observed to cause prolonged pauses in the delivery of vital chest compressions and reduce hands-on time.6,7 A structured protocol and quality assurance process may reduce these times.8 Nonetheless, TTE remains particularly challenging in patients who are obese, have gastric distention from air insufflation, or are barrel chested. In approximately one-third of patients, an adequate cardiac window cannot be obtained for interpretation during resuscitation.9 Transesophageal echocardiography (TEE), by contrast, offers several advantages over TTE in the setting of cardiac arrest. Cardiac windows can be obtained once the probe has been correctly positioned during CPR, offering continuous images during CPR. Image quality is superior to TTE as the transducer is placed directly behind the heart without significant intervening tissue. In our own ED, pauses in CPR were shorter with TEE vs. TTE, when performed by emergency physicians, since image acquisition was continuous. Mean pauses were 9 second...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Cardiac & Resuscitation Top Story Exclusive Articles Patient Care Heart of America Source Type: news