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

Abstract

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.

Intra-arrest transesophageal echocardiography during cardiopulmonary resuscitation

“…38 Transgastric views during chest compressions are not recommend because the forceful anterograde or retrograde flexion position for the transgastric views may cause injury to the esophagus or stomach. 56,57 After quick observation of the heart and great vessels, a TEE probe with a four-chamber view is placed at the ME level to monitor for cardiac movement and assist resuscitation measures. When catheterization is required for resuscitative measures, such as employing a central venous catheter, extracorporeal membrane oxygenation, or resuscitative endovascular balloon occlusion of the aorta (REBOA), ME bicaval view and the descending aorta SAX and/or LAX view are optimal for visualizing the vena cava or aorta.…”

“…1 ) [ 40 ]. Transgastric views during chest compressions are not recommend because the forceful anterograde or retrograde flexion position for the transgastric views may cause injury to the esophagus or stomach [ 58 , 59 ]. After quick observation of the heart and great vessels, a TEE probe with a four-chamber view is placed at the ME level to monitor for cardiac movement and assist resuscitation measures.…”