Transesophageal Echocardiography During Cardiopulmonary Resuscitation (CPR-TEE)

Abstract

Background: To take full advantage of transesophageal echocardiography (TEE) during cardiopulmonary resuscitation (CPR), we propose a flowchart derived from representative cases. Methods and Results: TEE was used in patients requiring CPR to obtain information potentially helpful for rescue. TEE navigated the CPR procedures (navigation TEE), identified the possible cause of arrest (focus TEE), and optimized treatment while checking for pitfalls (secure TEE). In addition, TEE corrected prehospital misdiagnoses and detected new complications caused by CPR. Conclusions: TEE provides valuable information without interrupting CPR procedures. It is hoped that our flowchart may facilitate goal-directed, efficient assessment.

Indications, Clinical Impact, and Complications of Critical Care Transesophageal Echocardiography: A Scoping Review

“…In many cases, ccTEE was reported to help clarify the etiology of shock ( Table 3 ). ccTEE was used to correctly identify right ventricular (RV) failure from acute pulmonary embolism, 30 – 34 for managing the peripartum patient with hemodynamic collapse, 35 , 36 and for identifying unexpected causes of shock like dynamic left ventricular outflow tract (LVOT) obstruction. 37 , 38 There were a number of case reports of ccTEE identifying rare causes of shock that may not have been visualized on TTE: right atrial compression from intrabdominal hematoma, 39 thoracic tamponade post lung transplant, 40 and regional pericardial tamponade in the ED after discharge home from cardiac surgery.…”

“… 52 Multiple studies reported that ccTEE identified fine ventricular fibrillation (VF) not seen on surface electrodes. 32 , 36 , 52 In one study, ccTEE detected pseudo-pulseless electrical activity (PEA) in 28% of cases of PEA, where ventricular contraction occurred but did not generate a palpable pulse. 52 Intra-arrest TEE was reported to improve CPR quality through guiding chest compressions to avoid ineffective compressions over the LVOT or aortic root.…”

“…42,43,82 Perhaps the most powerful application of ccTEE is its ability to quickly phenotype shock and identify causes that have targeted treatments such as pulmonary embolism, effusion, or severe ventricular dysfunction. [30][31][32][33][34][35][36][37][38][39][40]83,84 Its use to phenotype shock is valuable even when only core "resuscitative" TEE views are used, although refining management often requires additional views and quantitative measurements. A simplified "resuscitative" ccTEE protocol like the one shown in Figure 2 allows for the assessment of LV and RV function, pericardial disease, and catastrophic valvular failure.…”

“…60 TEE was also used to provide real-time guidance for the insertion of transvenous pacemakers. 36,61,62 ccTEE use in Trauma TEE use in trauma had high diagnostic accuracy (>90%) for the detection of traumatic aortic injuries. [63][64][65] After initial surgical hemostasis, TEE helped identify other etiologies of shock including LV and RV dysfunction, blunt cardiac injury, and traumatic valvular abnormalities.…”

Upper gastrointestinal bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography during successful cardiopulmonary resuscitation: A case report

“…Although generally considered to be safe, in a recent study of 22314 TEE examinations, there were 17 patients developed complications, including esophageal perforation and mucosal damage, and there were 7 deaths directly attributed to these complications, corresponding to an incidence of 0.08% and 0.03% respectively[ 7 ]. Because TEE can rapidly identify the reversible causes of arrest[ 9 ], guide the precise cannulation of extracorporeal cardiopulmonary resuscitation and optimize the treatment after the return of spontaneous circulation[ 10 ]. Therefore, TEE has been endorsed by reviews and guidelines as a well-suited imaging tool to improve cardiac arrest outcome[ 11 - 13 ].…”