Transesophageal Echocardiography during Cardiac Arrest in Orthopedic Surgery Patients: A Report of Two Cases and a Review of the Literature

Abstract

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.

Early Detection and Management of Massive Intraoperative Pulmonary Embolism in a Patient Undergoing Repair of a Traumatic Acetabular Fracture

“…Orthopedic and trauma patients are some of those at highest risk for thrombi, but cardiac anesthesiologists are seldom found administering these anesthetics. Although right ventricular strain is the most common finding in these cases, our patient showed a global deterioration [ 9 ]. One explanation is that the patient's extensive fracture resulted in occult bleeding which contributed to severe hemodynamic instability and cardiac arrest.…”

“…Intraoperative TEE is extremely useful for monitoring and diagnosis. One study discovered that in 19 out of 22 cardiac arrests, TEE was successful in establishing a diagnosis [ 9 ]. In addition, TEE provides a survival benefit, allowing clot visualization and initiation of specific treatment plans [ 2 , 9 ].…”

“…One study discovered that in 19 out of 22 cardiac arrests, TEE was successful in establishing a diagnosis [ 9 ]. In addition, TEE provides a survival benefit, allowing clot visualization and initiation of specific treatment plans [ 2 , 9 ]. Orthopedic and trauma patients are some of those at highest risk for thrombi, but cardiac anesthesiologists are seldom found administering these anesthetics.…”

Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery

“…So far, no study has assessed the impact of TOE on survival. [19][20][21][22] There are similar data from observational studies performed mostly in emergency settings regarding the value of echocardiography for diagnosis of the cause of cardiac arrest but not for improving outcomes. 23 One systematic review suggested that the absence of spontaneous cardiac motion seen with TOE in patients with a a low probability for ROSC may predict a low likelihood of survival as well as guide CPR decisions, but the clinical settings of the included studies were outside of the operating room.…”

Expanding role of perioperative transesophageal echocardiography in the general anesthesia practice and residency training in the USA

“…TEE for noncardiac surgical procedures is frequently used in cases such as liver transplantation, but also in cases with specific cardiac risks or in patient populations with significant cardiac comorbidities. Additionally, TEE may be used in situations when previously unrecognized cardiac conditions exist or in high-risk procedures to help guide resuscitative measures [4]. Because many life-threatening conditions (such as pericardial effusion or air embolism, for example) can be recognized in a more efficient manner by using TEE, those who have obtained basic certification should be able to recognize such conditions [5 && ].…”