Abstract 208: Can Transesophageal Echocardiography During CPR Change Resuscitation Outcomes in Prolonged Cardiac Arrest?

Abstract

Background and Purpose: Early diagnosis of a potential cause of cardiac arrest is crucial for resuscitating the cardiac arrest victim. Transesophageal echocardiography (TEE) provides an excellent window to visualize the heart and aorta without any interruption of resuscitation effort during cardiopulmonary resuscitation (CPR). This study was to investigate whether TEE during CPR influences resuscitation outcome in patients with non-traumatic adult cardiac arrest who receive prolonged resuscitation attempt. Subjects and Methods: This prospective observational study was conducted by analyzing the patients with non-traumatic adult cardiac arrest (age over 20 year-old) who underwent TEE during CPR in the emergency department of a university hospital. According to the availability of TEE and experienced emergency physicians, TEE was performed during CPR when resuscitation attempt was prolonged longer than 10 minutes. Patients were divided into two groups. TEE (+) group was composed of those who have any structural abnormality observed by TEE. TEE (-) group was those who have no structural abnormality. Primary outcome measure was restoration of spontaneous circulation (ROSC). Results: 108 patients (mean age: 69 year-old, 66 males) were enrolled. 31 patients (29%) were included in TEE(+) group and 77 patients (61%) were included in TEE(-) group. Abnormalities observed in TEE(+) group included aortic dissection in 18 patients, pulmonary thromboembolism (PTE) in 9 patients, cardiac tamponade in 3 patients and intra-cardiac thrombus in 1 patient. There was no significant difference in age, rate of bystander CPR, time from collapse to CPR, CPR duration, first monitoring ECG rhythm, and etiology of cardiac arrest between two groups. The rate of ROSC and survival discharge was not different between TEE(-) group and TEE (+) group (ROSC: 38 vs 29%, P = 0.268, survival discharge: 6.5 vs. 6.5%). Two patients with pulmonary PTE who received fibrinolysis survived. Conclusion: TEE during CPR does not change resuscitation outcomes in patients with prolonged cardiac arrest. However, resuscitation outcome might be changed with TEE in patients with specific etiology such as PTE or cardiac tamponade.