Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week

Felipe Teran; Michael I Prats; Bret P Nelson; Ross Kessler; Michael Blaivas; Mary Ann Peberdy; Sasha K Shillcutt; Robert T Arntfield; David Bahner

doi:10.1016/j.jacc.2020.05.074

Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week

J Am Coll Cardiol. 2020 Aug 11;76(6):745-754. doi: 10.1016/j.jacc.2020.05.074.

Authors

Felipe Teran¹, Michael I Prats², Bret P Nelson³, Ross Kessler⁴, Michael Blaivas⁵, Mary Ann Peberdy⁶, Sasha K Shillcutt⁷, Robert T Arntfield⁸, David Bahner²

Affiliations

¹ Division of Emergency Ultrasound and Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: felipe.teran-merino@pennmedicine.upenn.edu.
² Division of Ultrasound, Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
³ Division of Ultrasound, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington.
⁵ Department of Medicine, University of South Carolina School of Medicine. Department of Emergency Medicine, St. Francis Hospital, Columbia, South Carolina.
⁶ Division of Cardiology, Department of Internal Medicine, Weil Institute of Emergency and Critical Care, Department of Emergency Medicine, University Virginia Commonwealth University, Richmond, Virginia.
⁷ Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska.
⁸ Division of Critical Care Medicine, Western University, London, Ontario, Canada.

PMID: 32762909
DOI: 10.1016/j.jacc.2020.05.074

Abstract

Focused transthoracic echocardiography (TTE) during cardiac arrest resuscitation can enable the characterization of myocardial activity, identify potentially treatable pathologies, assist with rhythm interpretation, and provide prognostic information. However, an important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. Over the last decade, focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis-those in cardiac arrest and periarrest states. In addition to the same diagnostic and prognostic role provided by TTE images, TEE provides unique advantages including the potential to optimize the quality of chest compressions, shorten cardiopulmonary resuscitation interruptions, guide resuscitative procedures, and provides a continuous image of myocardial activity. This review discusses the rationale, supporting evidence, opportunities, and challenges, and proposes a research agenda for the use of focused TEE in cardiac arrest with the goal to improve resuscitation outcomes.

Keywords: cardiac arrest; focused cardiac ultrasound; point-of-care ultrasound; resuscitation; transesophageal echocardiography.

Publication types

Review

MeSH terms

Cardiopulmonary Resuscitation / methods*
Clinical Competence
Echocardiography, Transesophageal* / methods
Echocardiography, Transesophageal* / standards
Heart Arrest / diagnostic imaging*
Heart Arrest / therapy*
Humans
Quality Improvement