Usefulness of Point-of-Care Transesophageal Echocardiography in Cardiac Arrest to Identify the Area of Maximal...

Transesophageal echocardiography (TEE) enables real-time assessment of the area of maximal compression (AMC) during cardiopulmonary resuscitation (CPR). Compression of the left ventricular outflow tract, aortic valve, or aortic root occurs in 30% to 50% of cases, potentially reducing the likelihood of return of spontaneous circulation (ROSC) and organ perfusion.

Assess TEE feasibility in identifying the AMC during CPR and correlate optimal alignment with end-tidal carbon dioxide (EtCO₂) levels and ROSC rates.

In this prospective observational study, we enrolled patients with out-of-hospital cardiac arrest who were transported by ambulance to the emergency department (ED) for extracorporeal CPR (E-CPR) while receiving mechanical chest compressions. TEE was performed immediately on ED arrival to identify the AMC.

AMC evaluation with TEE was feasible in all 18 enrolled patients. At ED arrival, mechanical compression was correctly aligned with the AMC in six (33.3%) patients. Compressions delivered on the AMC were associated with significantly higher EtCO₂ values (mean, 33 mm Hg [AMC+] vs. 12.8 mm Hg [AMC-]; p = 0.004) and a greater likelihood of ROSC (odds ratio, 22; 95% confidence interval, 1.54-314; p = 0.011). However, no patient survived to hospital discharge.

TEE-guided evaluation of AMC during CPR is feasible in out-of-hospital cardiac arrest patients considered for E-CPR and reveals that in only one third of cases, mechanical compressions are aligned with the AMC. Compressions aligned with the AMC were associated with higher EtCO₂ values and ROSC rates, but not with survival to discharge.