Transesophageal Echocardiography During Cardiopulmonary Resuscitation Is Associated With Shorter Compression Pauses Compared With Transthoracic Echocardiography

Abstract

Point-of-care ultrasonography provides diagnostic information in addition to visual pulse checks during cardiopulmonary resuscitation (CPR). The most commonly used modality, transthoracic echocardiography, has unfortunately been repeatedly associated with prolonged pauses in chest compressions, which correlate with worsened neurologic outcomes. Unlike transthoracic echocardiography, transesophageal echocardiography does not require cessation of compressions for adequate imaging and provides the diagnostic benefit of point-of-care ultrasonography. To assess a benefit of transesophageal echocardiography, we compare the duration of chest compression pauses between transesophageal echocardiography, transthoracic echocardiography, and manual pulse checks on video recordings of cardiac arrest resuscitations.Methods: We analyzed 139 pulse check CPR pauses among 25 patients during cardiac arrest.Results: Transesophageal echocardiography provided the shortest mean pulse check duration (9 seconds [95% confidence interval {CI} 5 to 12 seconds]). Mean pulse check duration with transthoracic echocardiography was 19 seconds (95% CI 16 to 22 seconds), and it was 11 seconds (95% CI 8 to 14 seconds) with manual checks. Intraclass correlation coefficient between abstractors for a portion of individual and average times was 0.99 and 0.99, respectively (P<.001 for both). Conclusion:Our study suggests that pulse check times with transesophageal echocardiography are shorter versus with transthoracic echocardiography for ED point-of-care ultrasonography during cardiac arrest resuscitations, and further emphasizes the need for careful attention to compression pause duration when using transthoracic echocardiography for point-of-care ultrasonography during ED cardiac arrest resuscitations. [

A Case for the Use of Transesophageal Echocardiography in the ED Treatment of Cardiac Arrest

“…While prompt POCUS in CA is essential, TEE offers many advantages including assessment of the quality of chest compressions, [9][10][11] shorter pauses during CPR, 12 and early identification of pathology such as AADA in patients too unstable to undergo CT scanning. Although traditionally performed by a cardiologist, use of TEE by trained emergency physicians is increasing and may expedite patient care in undifferentiated CA.…”

Safety of Transesophageal Echocardiography Performed by Intensivists and Emergency Physicians in Critically Ill Patients With Coagulopathy and Thrombocytopenia: A Single-Center Experience

“…In the setting of cardiac arrest, TEE has been shown to reduce the duration of "hands-off time" during CPR compared to both transthoracic echocardiography and manual pulse checks. 6 In the ICU, the utility of TEE is being increasingly recognized, with TEE informing management changes in around 80% of cases. 2 The ASE 16 lists examples for which TEE may be preferred over TTE including patients with chest wall injuries, patients with body habitus preventing TTE imaging, and patients unable to assume the left lateral decubitus position.…”

“…In the setting of cardiac arrest, TEE has been shown to reduce the duration of “hands-off time” during CPR compared to both transthoracic echocardiography and manual pulse checks. 6 In the ICU, the utility of TEE is being increasingly recognized, with TEE informing management changes in around 80% of cases. 2…”

“…1,2 Agreement between cardiologist-and IP-performed TEE is high when used for diagnoses commonly seen in critically ill patients. 3 Further, TEE has been shown to change management when performed by an emergency physician (EP) in patients presenting to the emergency department (ED) during and immediately after cardiac arrest, [4][5][6][7] and its application has recently been expanded to the prehospital environment. 8,9 While TEE has long been viewed as safe in the perioperative [10][11] and elective 12 settings, there is less evidence in regard to the safety of TEE among patients in the intensive care unit (ICU).…”

Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic

“…In addition to the same diagnostic and prognostic role provided by TTE (e.g., identification of reversible causes such as cardiac tamponade or PE), TEE also provides several unique advantages that should be considered. During resuscitation, TEE has the potential to optimize the quality of chest compressions by identifying compression of the left ventricular outflow tract, 15,27 shorten chest compression interruptions, 28 and guide resuscitative procedures such as extracorporeal membrane oxygenation (ECMO). 29,30 In the case of patients with suspected or confirmed COVID-19, clinicians should carefully consider the potential benefits of this procedure against the risks, specifically to health care providers.…”