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Transesophageal echocardiography in patients with cardiac arrest: from high-quality chest compression to effective resuscitation

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Abstract

Background

Survival after cardiac arrest depends on prompt and effective cardiopulmonary resuscitation (CPR).

Transesophageal echocardiography (TEE) can be applied to evaluate the effectiveness of chest compression–decompression maneuvers in the setting of cardiac arrest undergoing CPR. The efficacy of chest compression can be continuously assessed by TEE that can improve the effectiveness of CPR guiding the rescuer to optimize or correct chest compression and decompression by directly examining the movements of the cardiac walls and valve leaflets.

Purpose

The review describes how to perform TEE in the emergency setting of cardiopulmonary arrest, its advantages, and limitations, and ultimately propose an echo-guided approach to CPR.

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Abbreviations

CPR:

Cardiopulmonary resuscitation

TEE:

Transesophageal echocardiography

LVOT:

Left ventricle outflow tract

MV:

Mitral valve

ROSC:

Return of spontaneous circulation

ME:

Mid-esophageal

LV:

Left ventricle

FE:

Ejection fraction

EDV:

End diastolic volume

ESV:

End systolic volume

FAC:

Fractional area change

FS:

Fractional shortening

RV-FAC:

Right ventricle fractional area change

LV-FAC:

Left ventricle fractional area change

RV:

Right ventricle

LWE:

Lateral wall excursion

RVOT:

Right-ventricular outflow tract

LA:

Left atrium

ET-CO2:

End-tidal carbon oxygen

AMC:

Area of maximal compression

RA:

Right atrium

LW shift:

Lateral wall shift

RT:

Relaxing time

DT:

Decompression time

DS:

Deceleration speed

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Author information

Authors and Affiliations

  1. Department of Anesthesia and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Via Claudio Monteverdi, 18, 20131, Milan, Italy

    Emanuele Catena, Riccardo Colombo, Alessandra Volontè, Beatrice Borghi, Paola Bergomi, Davide Ottolina, Tommaso Fossali, Elisa Ballone, Roberto Rech & Antonio Castelli

  2. Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy

    Donato Mele

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  1. Emanuele Catena
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  2. Riccardo Colombo
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Contributions

Dr. EC had the idea of the article, Dr. RC and Dr. ssa AV performed the literature and data analysis, Dr. DM critically revised the work and all the authors drafted the manuscript. All the authors read and approved the manuscript.

Corresponding author

Correspondence to Emanuele Catena.

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Conflict of interest

Emanuele Catena, Riccardo Colombo, Alessandra Volontè, Beatrice Borghi, Paola Bergomi, Davide Ottolina, Tommaso Fossali, Elisa Ballone, Roberto Rech, Antonio Castelli, and Donato Mele have no conflict of interest.

Human rights statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1. M-mode echocardiography of mid-esophageal 4-chamber view shows the right ventricular free wall displaced towards the interventricular septum under external cardiac massage (MP4 554 kb)

Video 2. The ME RV inflow-outflow view shows the compression of the RV outflow tract under external cardiac massage (MP4 262 kb)

Video 3. The mid-esophageal bicaval view shows the area of maximal compression located over the right and left atria under external cardiac massage (MP4 317 kb)

Video 4. M-mode echocardiography of mid-esophageal four chamber views shows active decompression performed by the LUCAS-2 mechanical device (MP4 466 kb)

Video 5. M-mode echocardiography of mid-esophageal four chamber views shows decompression under manual external cardiac massage (MP4 222 kb)

Video 6. M-mode echocardiography of mid-esophageal long axis view shows LVOT and aortic valve opening under compression and decompression (MP4 526 kb)

Video 7. M-mode echocardiography of mid-esophageal long axis view shows LVOT and aortic valve obstruction under compression and decompression (MP4 511 kb)

Supplementary file8 (MP4 368 kb)

Supplementary file9 (MP4 393 kb)

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Catena, E., Colombo, R., Volontè, A. et al. Transesophageal echocardiography in patients with cardiac arrest: from high-quality chest compression to effective resuscitation. J Echocardiogr 19, 28–36 (2021). https://doi.org/10.1007/s12574-020-00492-8

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  • DOI: https://doi.org/10.1007/s12574-020-00492-8

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