Felipe Teran1, Anthony J Dean2, Claire Centeno3, Nova L Panebianco2, Amy J Zeidan4, Wilma Chan2, Benjamin S Abella5. 1. Department of Emergency Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA; Center for Resuscitation Science, University of Pennsylvania School of Medicine, University of Pennsylvania Blockley Hall, 423 Guardian Drive, Room 414A, Philadelphia, PA 19104, USA. Electronic address: Felipe.Teran-Merino@uphs.upenn.edu. 2. Department of Emergency Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA. 3. Center for Resuscitation Science, University of Pennsylvania School of Medicine, University of Pennsylvania Blockley Hall, 423 Guardian Drive, Room 414A, Philadelphia, PA 19104, USA. 4. Department of Emergency Medicine, University of Kentucky Medical Center, 800 Rose Street, Room M-53, Lexington, KY 40536-0298, USA. 5. Department of Emergency Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA; Center for Resuscitation Science, University of Pennsylvania School of Medicine, University of Pennsylvania Blockley Hall, 423 Guardian Drive, Room 414A, Philadelphia, PA 19104, USA.
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.
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.
Authors: Christian Vaillancourt; Ashley Petersen; Eric N Meier; Jim Christenson; James J Menegazzi; Tom P Aufderheide; Graham Nichol; Robert Berg; Clifton W Callaway; Ahamed H Idris; Daniel Davis; Raymond Fowler; Debra Egan; Douglas Andrusiek; Jason E Buick; T J Bishop; M Riccardo Colella; Ritu Sahni; Ian G Stiell; Sheldon Cheskes Journal: Resuscitation Date: 2020-06-20 Impact factor: 5.262
Authors: Robert F Reardon; Elliott Chinn; Dave Plummer; Andrew Laudenbach; Andie Rowland Fisher; Will Smoot; Daniel Lee; Joseph Novik; Barrett Wagner; Chris Kaczmarczyk; Johanna Moore; Emily Thompson; Craig Tschautscher; Teresa Dunphy; Thomas Pahl; Michael A Puskarich; James R Miner Journal: Acad Emerg Med Date: 2021-11-06 Impact factor: 5.221
Authors: Felipe Teran; Shaun K McGovern; Katie N Dainty; Kelly N Sawyer; Audrey L Blewer; Michael C Kurz; Joshua C Reynolds; Jon C Rittenberger; Marina Del Rios Rivera; Marion Leary Journal: J Am Heart Assoc Date: 2019-05-07 Impact factor: 5.501
Authors: Felipe Teran; Claire Centeno; Alexander L Lindqwister; William J Hunckler; William P Landis; Karen L Moodie; Frances S Shofer; Benjamin S Abella; Norman A Paradis Journal: Resusc Plus Date: 2021-04-02