Transesophageal echocardiography in patients with cardiac arrest: from high-quality chest compression to effective resus
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REVIEW ARTICLE
Transesophageal echocardiography in patients with cardiac arrest: from high‑quality chest compression to effective resuscitation Emanuele Catena1 · Riccardo Colombo1 · Alessandra Volontè1 · Beatrice Borghi1 · Paola Bergomi1 · Davide Ottolina1 · Tommaso Fossali1 · Elisa Ballone1 · Roberto Rech1 · Antonio Castelli1 · Donato Mele2 Received: 10 January 2020 / Revised: 11 August 2020 / Accepted: 15 September 2020 © Japanese Society of Echocardiography 2020
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. Keywords Transesophageal echocardiography · Cardiac arrest · Cardiopulmonary resuscitation · External cardiac massage 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 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12574-020-00492-8) contains supplementary material, which is available to authorized users. * Emanuele Catena emanuele.catena@asst‑fbf‑sacco.it 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
Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
2
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
Introduction Survival after cardiac arrest depends on prompt and effective cardiopulmonary resuscitation (CPR). Forward blood flow during CPR is provided by compression of the heart between the sternum and the thoracic vertebrae (cardiac pump theory) or by intrathoracic pressure fluctuations (thoracic pump theory). The need for chest compressions is unquestionable: chest cardiac massage is the principal means of restoring blood flow supplying blood to the vital organs during CPR [1]. Al
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