Transoesophageal echocardiography in cardiac arrest: A systematic review

Hussein, Laila; Rehman, Mohammad Anzal; Jelić, Tomislav; Бердников, А. В.; Teran, Felipe; Richards, Simon; Askin, Nicole; Jarman, Robert

doi:10.1016/j.resuscitation.2021.08.001

Cited by 25 publications

(3 citation statements)

References 44 publications

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“…Although generally considered to be safe, in a recent study of 22314 TEE examinations, there were 17 patients developed complications, including esophageal perforation and mucosal damage, and there were 7 deaths directly attributed to these complications, corresponding to an incidence of 0.08% and 0.03% respectively[ 7 ]. Because TEE can rapidly identify the reversible causes of arrest[ 9 ], guide the precise cannulation of extracorporeal cardiopulmonary resuscitation and optimize the treatment after the return of spontaneous circulation[ 10 ]. Therefore, TEE has been endorsed by reviews and guidelines as a well-suited imaging tool to improve cardiac arrest outcome[ 11 - 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clinicians should take a risk vs benefit assessment on each individual patient before the application of TEE during CPR. The risk factors include but not limited to: Non-standard resuscitation; co-existing gastrointestinal disease or coagulopathy; periods of probe insertion and manipulation; periods of low cardiac output and non-pulsatile flow; increased frailty; and musculoskeletal disorders and the use of steroids[ 9 , 22 ]. TTE should be a priority.…”

Section: Discussionmentioning

confidence: 99%

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Upper gastrointestinal bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography during successful cardiopulmonary resuscitation: A case report

Tang¹,

Fang²,

Liu³

2022

WJCC

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BACKGROUND In recent years, it has been recognized that transesophageal echocardiography (TEE) is of great value in resuscitation of cardiac arrest. However, its safety has rarely been reported. CASE SUMMARY We present a 59-year-old male patient scheduled to undergo cardiac surgery for rheumatic heart disease. Upper gastrointestinal bleeding from a Mallory-Weiss tear appeared following cardiopulmonary resuscitation, TEE, and percutaneous cardiopulmonary bypass resuscitation when he suffered from aesthesia-related cardiac arrest. Gastrointestinal injury was diagnosed promptly and treated effectively. However, the exact etiology of gastrointestinal injury was unclear; the interaction of closed-chest cardiac massage and the application of TEE may be involved as a most possible mechanism of injury. CONCLUSION Serious complications should be considered when TEE is used in patients with special pathophysiological conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography during successful cardiopulmonary resuscitation: A case report

Tang¹,

Fang²,

Liu³

2022

WJCC

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“…TOE is valuable in patients during and after cardiac arrest, both intra-operatively 9 and in ED, 10 to identify causes and assess efficacy of chest compression during cardiopulmonary resuscitation without hampering resuscitation efforts. 11…”

Section: Indications and Rationale For Perioperative/critical Care Fo...mentioning

confidence: 99%

Focused transoesophageal TOE (fTOE): A new accreditation pathway

Rubino

Peck

Miller

et al. 2023

Journal of the Intensive Care Society

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The concept of a focused ultrasound study to identify sources of haemodynamic instability has revolutionized patient care. Point-of-care ultrasound (POCUS) using transthoracic scanning protocols, such as FUSIC Heart, has empowered non-cardiologists to rapidly identify and treat the major causes of haemodynamic instability. There are, however, circumstances when a transoesphageal, rather than transthoracic approach, may be preferrable. Due to the close anatomical proximity between the oesophagus, stomach and heart, a transoesphageal echocardiogram (TOE) can potentially overcome many of the limitations encountered in patients with poor transthoracic ultrasound windows. These are typically patients with severe obesity, chest wall injuries, inability to lie in the left lateral decubitus position and those receiving high levels of positive airway pressure. In 2022, to provide all acute care practitioners with the opportunity to acquire competency in focused TOE, the Intensive Care Society (ICS) and Association of Anaesthetists (AA) launched a new accreditation pathway, known as Focused Transoesophageal Echo (fTOE). The aim of fTOE is to provide the practitioner with the necessary information to identify the aetiology of haemodynamic instability. Focused TOE can be taught in a shorter period of time than comprehensive and teaching programmes are achievable with support from cardiothoracic anaesthetists, intensivists and cardiologists. Registration for fTOE accreditation requires registration via the ICS website. Learning material include theoretical modules, clinical cases and multiple-choice questions. Fifty fTOE examinations are required for the logbook, and these must cover a range of pathology, including ventricular dysfunction, pericardial effusion, tamponade, pleural effusion and low preload. The final practical assessment may be undertaken when the supervisors deem the candidate’s knowledge and skills consistent with that required for independent practice. After the practitioner has been accredited in fTOE, they must maintain knowledge and competence through relevant continuing medical education. Accreditation in fTOE represents a joint venture between the ICS and AA and is endorsed by Association of Cardiothoracic Anaesthesia and Critical care (ACTACC). The process is led by TOE experts, and represents a valuable expansion in the armamentarium of acute care practitioners to assess haemodynamically unstable patients.

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