Transesophageal echocardiography during cardiac arrest in orthopedic surgery patients: a report of two cases and a review of the literature.

BACKGROUND: Cardiac arrest situations represent an enormous clinical challenge to the physicians involved. Research suggests that the utilization on transesophageal echocardiography (TEE) may provide important diagnostic information and allows for institution of more specific treatment, while not hampering resuscitation efforts. CASE DESCRIPTION: In this review, we highlight the usefulness of TEE in cardiac arrest situations in the orthopedic setting, by presenting two perioperative cases. In one case, TEE was used to diagnose intraoperative pulmonary embolism and guide thrombolytic therapy. The second case highlights the use of TEE in management of hemodynamic instability in a patient with aortic stenosis. LITERATURE REVIEW: Memtsoudis et al. showed that in 19 of 22 cardiac arrests, an underlying pathological process could be established with TEE, leading to specific interventions beyond the institution of advanced cardiac life support measures. CLINICAL RELEVANCE: TEE can provide rapid diagnostic information guiding treatment in patients with hemodynamic compromise. The use is expanding beyond the cardiac operating theater and given the potential clinical impact consideration should be given to utilizing this valuable imaging modality in appropriate clinical situation.