Abstract 197: Location, Location, Location! Association Of Success In Transthoracic Echocardiography Image Acquisition With Location During Cardiopulmonary Resuscitation.

Abstract

Introduction: Currently, no consensus exists regarding the ideal location for obtaining a transthoracic echocardiography (TTE) image during cardiopulmonary resuscitation (CPR). Of the three common locations, sub-xiphoid (SX), parasternal (PS) and apical (AP), the SX is most frequently used in cardiac arrest (CA) to avoid interfering with CPR. The recent adoption of mechanical chest compression devices may have led to increased use of alternate locations. We aim to assess the association between successful TTE image acquisition and the locations, also to compare the duration of CPR interruptions at each location. Hypothesis: We hypothesized that PS location will have a higher success rate compared to SX, but not a longer CPR interruption time. Methods: This is a retrospective study of all video-recorded non-traumatic, CA patients ≥18 years old in a quaternary care Emergency Department (ED) from 08/07/2019 to 05/18/2022 where an intra-arrest TTE was performed. Video recordings of cardiac arrest patients were reviewed by 2 physicians with years of experience and a well-established process. Successful image acquisition was defined as 1) visualization of the heart on the ultrasound machine or 2) clinicians verbalizing visualization in the video recording. Chi-square and Kruskal-Wallis tests were performed to compare the success rates and duration of CPR interruptions based on TTE locations. Our health system’s Institutional Review Board approved the conduct of this study. Results: A total of 59 patients yielded a combined 154 video recorded TTE attempts 90 (58.4%) SX, 56 (36.4%) PS, and 8 (5.2%) AP. Median age was 81 years, 50.8% female, 81.4% non-shockable initial rhythm, and 89.8% were receiving mechanical CPR. Because there were only 8 AP attempts, PS and SX were the only locations analyzed. PS was successful in 89.3% (68 of 90) compared to 75.6% (50 of 56) for the SX (p=0.04). The median duration of interruptions for PS was 17.5 seconds (IQR: 12.0, 22.0) compared to 15 seconds (IQR: 11.0, 24.0) for SX (p=0.5). Conclusion: During CPR, PS location for TTE image acquisition is associated with higher success when compared to SX. However, the median CPR interruption times are not significantly different.