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Teran F, West FM, Jelic T, Taylor L, Jafry ZM, Burns KM, Owyang CG, Emt CC, Abella BS, Andrus P. Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey. Am J Emerg Med 2024; 76:164-172. [PMID: 38086182 DOI: 10.1016/j.ajem.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Over the past two decades, transesophageal echocardiography (TEE) has been used with increasing frequency to evaluate critically ill patients outside of traditional settings. The purpose of this study was to characterize the number of programs, users, practice characteristics, training and competency requirements and barriers for the current use of resuscitative transesophageal echocardiography (TEE) in Emergency Departments (EDs) in the United States and Canada. METHODS A closed internet-based, cross-sectional, point-prevalence survey was administered via email to 120 program directors of emergency ultrasound fellowships (EUSF) and 43 physicians from EDs without EUSF from the United States and Canada. RESULTS Ninety-eight percent of surveyed participants responded. Twenty percent of respondents reported having active resuscitative TEE programs. The majority of participating hospitals (70%) were academic centers with residency programs. A total of 33 programs reported using resuscitative TEE in their ED and of those, 82% were programs with EUSF. Most programs performing TEE (79%) had less than five attending physicians performing TEE. Evaluation of patients during resuscitation from cardiac arrest (100%) and post-arrest care (76%) are the two most frequent indications for TEE in the ED. The most common core elements of resuscitative TEE protocols used are: assessment of left ventricular (LV) systolic function (97%), assessment of right ventricular (RV) function (88%), evaluation of pericardial effusion / tamponade (52%). All programs reported using formal didactics in their training programs, 94% reported using high-fidelity simulation, and 79% live scanning of patients. Financial concerns were the most common barrier use of TEE in the ED (58%), followed by maintenance of equipment (30%), and credentialing/privileges (30%). CONCLUSIONS This study provides a snapshot of the practice of resuscitative TEE in EDs in the United States and Canada revealing the existence of 33 programs using this emerging modality in the care of critically ill patients.
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Affiliation(s)
- Felipe Teran
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Frances Mae West
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Thomas Jefferson University, Pennsylvania, PA, USA
| | - Tom Jelic
- Department of Emergency Medicine, University of Winnipeg, Manitoba, MB, Canada
| | - Lindsay Taylor
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Zan M Jafry
- Department of Emergency Medicine, Loma Linda University, CA, USA
| | - Katharine M Burns
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Clark G Owyang
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Joan and Stanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Claire Centeno Emt
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin S Abella
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip Andrus
- Department of Emergency Medicine, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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2
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Krammel M, Hamp T, Hafner C, Magnet I, Poppe M, Marhofer P. Feasibility of resuscitative transesophageal echocardiography at out-of-hospital emergency scenes of cardiac arrest. Sci Rep 2023; 13:20085. [PMID: 37973909 PMCID: PMC10654663 DOI: 10.1038/s41598-023-46684-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
Guidelines recommend the use of ultrasound in cardiac arrest. Transthoracic echocardiography, has issues with image quality and by increasing hands-off times during resuscitation. We assessed the feasibility of transesophageal echocardiography (TEE), which does not have both problems, at out-of-hospital cardiac arrest (OHCA) emergency scenes. Included were 10 adults with non-traumatic OHCA in Vienna, Austria. An expert in emergency ultrasound was dispatched to the scenes in addition to the resuscitation team. Feasibility was defined as the ability to collect specific items of information by TEE within 10 min. Descriptive statistics were compiled and hands-off times were compared to a historical control group. TEE examinations were feasible in 9 of 10 cases and prompted changes in clinical management in 2 cases (cardiac tamponade: n = 1; right ventricular dilatation: n = 1). Their mean time requirement was 5.1 ± 1.7 (2.8-8.0) min, and image quality was invariably rated as excellent or good during both compressions and pauses. No TEE-related complications, or interferences with activities of advanced life support were observed. The hands-off times during resuscitation were comparable to a historical control group not involving ultrasound (P = 0.24). Given these feasibility results, we expect that TEE can be used routinely at OHCA emergency scenes.
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Affiliation(s)
- Mario Krammel
- Emergency Medical Service Vienna, Radetzkystrasse 1, 1030, Vienna, Austria
- PULS Austrian Cardiac Arrest Awareness Association, Lichtentaler Gasse 4/1/R03, 1090, Vienna, Austria
| | - Thomas Hamp
- Emergency Medical Service Vienna, Radetzkystrasse 1, 1030, Vienna, Austria.
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Christina Hafner
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ingrid Magnet
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Peter Marhofer
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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3
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Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2023; 82:e115-e155. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
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Kongkatong M, Ottenhoff J, Thom C, Han D. Focused Ultrasonography in Cardiac Arrest. Emerg Med Clin North Am 2023; 41:633-675. [PMID: 37391255 DOI: 10.1016/j.emc.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Rapid diagnostic tools available to the emergency physician caring for cardiac arrest patients are limited. Focused ultrasound (US), and in particular, focused echocardiography, is a useful tool in the evaluation of patients in cardiac arrest. It can help identify possible causes of cardiac arrest like tamponade and pulmonary embolism, which can guide therapy. US can also yield prognostic information, with lack of cardiac activity being highly specific for failure to achieve return of spontaneous circulation. US may also be used to aid in procedural guidance. Recently, focused transesophageal echocardiography has been used in the emergency department setting.
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Affiliation(s)
- Matthew Kongkatong
- Department of Emergency Medicine, University of Virginia Health, 1215 Lee Street, Charlottesville, VA 22908, USA.
| | - Jakob Ottenhoff
- Department of Emergency Medicine, University of Virginia Health, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Christopher Thom
- Department of Emergency Medicine, University of Virginia Health, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - David Han
- Department of Emergency Medicine, University of Virginia Health, 1215 Lee Street, Charlottesville, VA 22908, USA
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5
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Prager R, Bowdridge J, Pratte M, Cheng J, McInnes MDF, Arntfield R. Indications, Clinical Impact, and Complications of Critical Care Transesophageal Echocardiography: A Scoping Review. J Intensive Care Med 2023; 38:245-272. [PMID: 35854414 PMCID: PMC9806486 DOI: 10.1177/08850666221115348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Critical care transesophageal echocardiography (ccTEE) is an increasingly popular tool used by intensivists to characterize and manage hemodynamics at the bedside. Its usage appears to be driven by expanded diagnostic scope as well as the limitations of transthoracic echocardiography (TTE) - lack of acoustic windows, patient positioning, and competing clinical interests (eg, the need to perform chest compressions). The objectives of this scoping review were to determine the indications, clinical impact, and complications of ccTEE. METHODS MEDLINE, EMBASE, Cochrane, and six major conferences were searched without a time or language restriction on March 31st, 2021. Studies were included if they assessed TEE performed for adult critically ill patients by intensivists, emergency physicians, or anesthesiologists. Intraoperative or post-cardiac surgical TEE studies were excluded. Study demographics, indication for TEE, main results, and complications were extracted in duplicate. RESULTS Of the 4403 abstracts screened, 289 studies underwent full-text review, with 108 studies (6739 patients) included. Most studies were retrospective (66%), performed in academic centers (84%), in the intensive care unit (73%), and were observational (55%). The most common indications for ccTEE were hemodynamic instability, trauma, cardiac arrest, respiratory failure, and procedural guidance. Across multiple indications, ccTEE was reported to change the diagnosis in 52% to 78% of patients and change management in 32% to79% patients. During cardiac arrest, ccTEE identified the cause of arrest in 25% to 35% of cases. Complications of ccTEE included two cases of significant gastrointestinal bleeding requiring intervention, but no other major complications (death or esophageal perforation) reported. CONCLUSIONS The use of ccTEE has been described for the diagnosis and management of a broad range of clinical problems. Overall, ccTEE was commonly reported to offer additional diagnostic yield beyond TTE with a low observed complication rate. Additional high quality ccTEE studies will permit stronger conclusions and a more precise understanding of the trends observed in this scoping review.
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Affiliation(s)
- Ross Prager
- Division of Critical Care, Western University, Stn B. London, ON, Canada,Ross Prager, Critical Care Trauma Centre,
Victoria Hospital. Rm # D2-528 London Health Sciences Centre, 800 Commissioners
Rd. E, London, ON N6A 5W9, Canada.
| | - Joshua Bowdridge
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Pratte
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jason Cheng
- Division of Critical Care, Western University, Stn B. London, ON, Canada
| | - Matthew DF McInnes
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada, Clinical Epidemiology Program, The Ottawa Hospital Research
Institute, Ottawa, ON, Canada
| | - Robert Arntfield
- Division of Critical Care, Western University, Stn B. London, ON, Canada
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6
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Poppe M, Magnet IAM, Clodi C, Mueller M, Ettl F, Neumayer D, Losert H, Zeiner-Schatzl A, Testori C, Roeggla M, Schriefl C. Resuscitative transoesophageal echocardiography performed by emergency physicians in the emergency department: insights from a 1-year period. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:124-128. [PMID: 36443280 DOI: 10.1093/ehjacc/zuac150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
AIMS Transoesophageal echocardiography (TOE) has increasingly been described as a possible complementary and point-of-care approach for patients with cardiac arrest (CA). It provides information about potentially reversible causes and prognosis and allows monitoring of resuscitation efforts without affecting ongoing chest compressions. The aim of this study was to assess the feasibility of TOE performed by emergency physicians (EPs) during CA in an emergency department (ED). METHODS AND RESULTS This prospective study was performed at the Department of Emergency Medicine at the Medical University of Vienna from February 2020 to February 2021. All patients of ≥18 years old presenting with ongoing resuscitation efforts were screened. After exclusion of potential contraindications, a TOE examination was performed and documented by EPs according to a standardized four-view imaging protocol. The primary endpoint represents feasibility defined as successful probe insertion and acquisition of interpretable images. Of 99 patients with ongoing non-traumatic CA treated in the ED, a total of 62 patients were considered to be examined by TOE. The examination was feasible in 57 patients (92%) [females, 14 (25%), mean age 53 ± 13, and witnessed collapse 48 (84%)]. Within these, the examiners observed 51 major findings in 32 different patients (66%). In 21 patients (37%), these findings led to a direct change of therapy. In 18 patients (32%), the examiner found ventricular contractions without detectable pulse. No TOE-related complications were found. CONCLUSION Our findings suggest that EPs may be able to acquire and interpret TOE images in the majority of patients during CA using a standardized four-view imaging protocol.
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Affiliation(s)
- Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Ingrid A M Magnet
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - David Neumayer
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Andrea Zeiner-Schatzl
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Martin Roeggla
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
| | - Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20/6D, 1090 Vienna, Austria
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7
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar J, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Pediatrics 2023; 151:189896. [PMID: 36325925 DOI: 10.1542/peds.2022-060463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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8
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Ong YKG, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Palazzo FS, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2022; 146:e483-e557. [PMID: 36325905 DOI: 10.1161/cir.0000000000001095] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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9
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Rosseel T, Van Puyvelde T, Voigt JU, Dauwe D, Meyns B, Dewolf P, Vandenbriele C. How to perform focused transoesophageal echocardiography during extracorporeal cardiopulmonary resuscitation? Eur Heart J Cardiovasc Imaging 2022; 24:12-14. [PMID: 36227723 DOI: 10.1093/ehjci/jeac205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Thomas Rosseel
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Tim Van Puyvelde
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Dieter Dauwe
- Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Philippe Dewolf
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Christophe Vandenbriele
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.,Royal Brompton, Adult Intensive Care Unit, Sydney Street, London SW3 6NP, UK
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10
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2022; 181:208-288. [PMID: 36336195 DOI: 10.1016/j.resuscitation.2022.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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Gottlieb M, Alerhand S. Managing Cardiac Arrest Using Ultrasound. Ann Emerg Med 2022; 81:532-542. [PMID: 36334956 DOI: 10.1016/j.annemergmed.2022.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022]
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Reardon RF, Chinn E, Plummer D, Laudenbach A, Rowland Fisher A, Smoot W, Lee D, Novik J, Wagner B, Kaczmarczyk C, Moore J, Thompson E, Tschautscher C, Dunphy T, Pahl T, Puskarich MA, Miner JR. Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice. Acad Emerg Med 2022; 29:334-343. [PMID: 34644420 PMCID: PMC9298053 DOI: 10.1111/acem.14399] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/10/2021] [Accepted: 09/19/2021] [Indexed: 01/15/2023]
Abstract
Introduction Transthoracic echocardiography (TTE) is a standard procedure for emergency physicians (EPs). Transesophageal echocardiography (TEE) is known to have great utility in patients who are critically ill or in cardiac arrest and has been used by some EPs with specialized ultrasound (US) training, but it is generally considered outside the reach of the majority of EPs. We surmised that all of our EPs could learn to perform focused TEE (F‐TEE), so we trained and credentialed all of the physicians in our group. Methods We trained 52 EPs to perform and interpret F‐TEEs using a 4‐h simulator‐based course. We kept a database of all F‐TEE examinations for quality assurance and continuous quality feedback. Data are reported using descriptive statistics. Results Emergency physicians attempted 557 total F‐TEE examinations (median = 10, interquartile range = 5–15) during the 42‐month period following training. Clinically relevant images were obtained in 99% of patients. EPs without fellowship or other advanced US training performed the majority of F‐TEEs (417, 74.9%) and 94.3% (95% confidence interval [CI] = 91.4%–96.3%) had interpretable images recorded. When TTE and TEE were both performed (n = 410), image quality of TEE was superior in 378 (93.3%, 95% CI = 89.7%–95%). Indications for F‐TEE included periarrest states (55.7%), cardiac arrest (32.1%), and shock (12.2%). There was one case of endotracheal tube dislodgement during TEE placement, but this was immediately identified and replaced without complication. Conclusion After initiating a mandatory group F‐TEE training and credentialing program, we report the largest series to date of EP‐performed resuscitative F‐TEE. The majority of F‐TEE examinations (75%) were performed by EPs without advanced US training beyond residency.
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Affiliation(s)
- Robert F. Reardon
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Elliott Chinn
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Dave Plummer
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Andrew Laudenbach
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Andie Rowland Fisher
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Will Smoot
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Daniel Lee
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Joseph Novik
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Barrett Wagner
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Chris Kaczmarczyk
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Johanna Moore
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Emily Thompson
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Craig Tschautscher
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Teresa Dunphy
- Department of Emergency Medicine Hennepin County Medical Center Minneapolis Minnesota USA
| | - Thomas Pahl
- Glacial Ridge Health System Glenwood Minnesota USA
| | - Michael A. Puskarich
- Department of Emergency Medicine Hennepin County Medical Center & University of Minnesota Medical School Minneapolis Minnesota USA
| | - James R. Miner
- Department of Emergency Medicine Hennepin County Medical Center & University of Minnesota Medical School Minneapolis Minnesota USA
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Horton RW, Niknam KR, Lobo V, Pade KH, Jones D, Anderson KL. A cadaveric model for transesophageal echocardiography transducer placement training: A pilot study. World J Emerg Med 2022; 13:18-22. [PMID: 35003410 DOI: 10.5847/wjem.j.1920-8642.2022.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 06/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transesophageal echocardiography (TEE) is used in the emergency department to guide resuscitation during cardiac arrest. Insertion of a TEE transducer requires manual skill and experience, yet in some residency programs cardiac arrest is uncommon, so some physicians may lack the means to acquire the manual skills to perform TEE in clinical practice. For other infrequently performed procedural skills, simulation models are used. However, there is currently no model that adequately simulates TEE transducer insertion. The aim of this study is to evaluate the feasibility and efficacy of using a cadaveric model to teach TEE transducer placement among novice users. METHODS A convenience sample of emergency medicine residents was enrolled during a procedure education session using cadavers as tissue models. A pre-session assessment was used to determine prior knowledge and confidence regarding TEE manipulation. Participants subsequently attended a didactic and hands-on education session on TEE placement. All participants practised placing the TEE transducer until they were able to pass a standardized assessment of technical skill (SATS). After the educational session, participants completed a post-session assessment. RESULTS Twenty-five residents participated in the training session. Mean assessment of knowledge improved from 6.2/10 to 8.7/10 (95% confidence interval [CI] of knowledge difference 1.6-3.2, P<0.001) and confidence improved from 1.6/5 to 3.1/5 (95% CI of confidence difference 1.1-2.0, P<0.001). There was no relationship between training level and the delta in knowledge or confidence. CONCLUSIONS In this pilot study, the use of a cadaveric model to teach TEE transducer placement methods among novice users is feasible and improves both TEE manipulation knowledge and confidence levels.
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Affiliation(s)
- Ryan W Horton
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto 94304, USA.,Emergency Medicine Residency Program, University of Texas at Austin Dell Medical School, Austin 78756, USA
| | - Kian R Niknam
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto 94304, USA.,University of California San Francisco School of Medicine, San Francisco 94143, USA
| | - Viveta Lobo
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto 94304, USA
| | - Kathryn H Pade
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto 94304, USA.,Department of Emergency Medicine, Rady Children's Hospital, San Diego 92123, USA
| | - Drew Jones
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto 94304, USA.,Department of Emergency Medicine, University of Central Florida/HCA Ocala Regional, Ocala 34471, USA
| | - Kenton L Anderson
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto 94304, USA
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Diagnostic Test Accuracy of Point-of-Care Ultrasound During Cardiopulmonary Resuscitation to Indicate the Etiology of Cardiac Arrest: A Systematic Review. Resuscitation 2022; 172:54-63. [DOI: 10.1016/j.resuscitation.2022.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023]
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Hussein L, Rehman MA, Jelic T, Berdnikov A, Teran F, Richards S, Askin N, Jarman R. Transoesophageal echocardiography in cardiac arrest: A systematic review. Resuscitation 2021; 168:167-175. [PMID: 34390824 DOI: 10.1016/j.resuscitation.2021.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
AIMS To identify, appraise and synthesize all available clinical evidence to evaluate the diagnostic role of transoesophageal echocardiography (TEE) during resuscitation of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) in the identification of reversible causes of cardiac arrest and cardiac contractility. METHODS We conducted a systematic review following PRISMA guidelines. Medline, EMBASE, Web of Science Core Collection, Proquest Dissertations, Open Grey, CDSR, Cochrane Central, Cochrane Clinical Answers, and the clinicaltrials.gov registry were searched for eligible studies. Studies involving adult patients, with non-traumatic cardiac arrest in whom TEE was used for intra-arrest evaluation, were included. Case studies and case series, animal studies, reviews, guidelines and editorials were excluded. The QUADAS-2 tool was used for quality assessment of all studies. RESULTS Eleven studies with a total of 358 patients were included. Four studies involved perioperative IHCA, three involved OHCA, and four were mixed population settings. Overall, the risk of bias in the selected studies was either high or unclear due to evidence or lack of information. In all 11 studies, TEE allowed the identification of reversible causes of arrest. We found significant heterogeneity in the criteria used to interpret findings, TEE protocol used, and timing of TEE. CONCLUSION Due to heterogeneity of studies, small sample size and inconsistent reference standard, the evidence for TEE in cardiac arrest resuscitation is of low certainty and is affected by a high risk of bias. Further studies are needed to better understand the true diagnostic accuracy of TEE in identifying reversible causes of arrest and cardiac contractility.
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Affiliation(s)
- Laila Hussein
- Teesside University, Middlesbrough, United Kingdom; Department of Emergency Medicine, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates.
| | - Mohammad Anzal Rehman
- Department of Emergency Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Felipe Teran
- Center for Resuscitation Science, University of Pennsylvania School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | | | - Robert Jarman
- Teesside University, Middlesbrough, United Kingdom; Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Teran F, Prats MI, Nelson BP, Kessler R, Blaivas M, Peberdy MA, Shillcutt SK, Arntfield RT, Bahner D. Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 76:745-754. [PMID: 32762909 DOI: 10.1016/j.jacc.2020.05.074] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022]
Abstract
Focused transthoracic echocardiography (TTE) during cardiac arrest resuscitation can enable the characterization of myocardial activity, identify potentially treatable pathologies, assist with rhythm interpretation, and provide prognostic information. However, an important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. Over the last decade, focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis-those in cardiac arrest and periarrest states. In addition to the same diagnostic and prognostic role provided by TTE images, TEE provides unique advantages including the potential to optimize the quality of chest compressions, shorten cardiopulmonary resuscitation interruptions, guide resuscitative procedures, and provides a continuous image of myocardial activity. This review discusses the rationale, supporting evidence, opportunities, and challenges, and proposes a research agenda for the use of focused TEE in cardiac arrest with the goal to improve resuscitation outcomes.
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Affiliation(s)
- Felipe Teran
- Division of Emergency Ultrasound and Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Michael I Prats
- Division of Ultrasound, Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bret P Nelson
- Division of Ultrasound, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ross Kessler
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Michael Blaivas
- Department of Medicine, University of South Carolina School of Medicine. Department of Emergency Medicine, St. Francis Hospital, Columbia, South Carolina
| | - Mary Ann Peberdy
- Division of Cardiology, Department of Internal Medicine, Weil Institute of Emergency and Critical Care, Department of Emergency Medicine, University Virginia Commonwealth University, Richmond, Virginia
| | - Sasha K Shillcutt
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert T Arntfield
- Division of Critical Care Medicine, Western University, London, Ontario, Canada
| | - David Bahner
- Division of Ultrasound, Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Kim YW, Jung WJ, Cha KC, Roh YI, Kim YS, Kim OH, Cha YS, Kim H, Lee KH, Hwang SO. Diagnosis of aortic dissection by transesophageal echocardiography during cardiopulmonary resuscitation. Am J Emerg Med 2021; 39:92-95. [DOI: 10.1016/j.ajem.2020.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022] Open
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Transesophageal echocardiography in patients with cardiac arrest: from high-quality chest compression to effective resuscitation. J Echocardiogr 2020; 19:28-36. [PMID: 33245547 DOI: 10.1007/s12574-020-00492-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 08/11/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Survival after cardiac arrest depends on prompt and effective cardiopulmonary resuscitation (CPR). Transesophageal echocardiography (TEE) can be applied to evaluate the effectiveness of chest compression-decompression maneuvers in the setting of cardiac arrest undergoing CPR. The efficacy of chest compression can be continuously assessed by TEE that can improve the effectiveness of CPR guiding the rescuer to optimize or correct chest compression and decompression by directly examining the movements of the cardiac walls and valve leaflets. PURPOSE The review describes how to perform TEE in the emergency setting of cardiopulmonary arrest, its advantages, and limitations, and ultimately propose an echo-guided approach to CPR.
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Intra-arrest transoesophageal echocardiographic findings and resuscitation outcomes. Resuscitation 2020; 154:31-37. [DOI: 10.1016/j.resuscitation.2020.06.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
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Transesophageal echocardiography (TEE) in cardiac arrest: results of a hands-on training for a simplified TEE protocol. Ultrasound J 2020; 12:41. [PMID: 32808100 PMCID: PMC7431479 DOI: 10.1186/s13089-020-00189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background Integration of transesophageal echocardiography (TEE) with Focused Cardiac Ultrasound (FoCUS) can impact decision-making, assist in the diagnosis of reversible etiologies and help guiding resuscitation of patients with cardiac arrest. Objective To evaluate the ability of emergency physicians (EPs) to obtain and maintain skills in performing resusTEE after a course with clinical training in the cardiac surgery theatre. Methods Ten EPs without previous TEE experience underwent a resusTEE course, based on a 2-h workshop and an 8-h hands-on training. The training was performed in a cardiac surgery theatre tutored by cardiovascular anesthesiologists. The six taught views were mid-esophageal four-chamber (ME4CH), mid-esophageal long axis (MELAX), mid-esophageal two-chamber (ME2CH), mid-esophageal bicaval view (MEbicaval), transgastric short axis (TGSAX) and aorta view (AOview). The EPs were evaluated by a cardiovascular anesthesiologist at the end of the course as well as after 12 weeks according to a standardized evaluation method. Once the course was completed, resusTEE exams, performed by EPs in Emergency Department (ED), were monitored for a 12-week period. Results The average assessment of the ten EPs by the tutors was higher than 4 points out of 5, both at the end of the course and after 12 weeks. Probe insertion, acquisition and interpretation of the different views scored on average more than 4 points out of 5 except for TGSAX that showed worsening after 12 weeks. Trainees performed twelve resusTEE exams in ED in patients with out-of-hospital cardiac arrest (OHCA) over 12 weeks after the course. EPs used only four out of six taught views in clinical practice, in the following order of frequency: ME4CH, AOview, MEbicaval and MELAX. Conclusions EPs, after a course with clinical training in the cardiac surgery theatre, can successfully acquire and maintain the skills needed to perform resusTEE. However, among the six views learned in the course, EPs used only four of them (ME4CH, MEbicaval, MELAX and AOview).
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Hansen K, Machin R, James J, Coats T, Rutty GN. A look inside cardiopulmonary resuscitation: A 4D computed tomography model of simulated closed chest compression. A proof of concept. Resuscitation 2020; 153:149-153. [PMID: 32526250 DOI: 10.1016/j.resuscitation.2020.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/30/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
AIM To mimic chest compression during cardiopulmonary resuscitation (CPR), this study aimed to produce time-resolved 3D (volumetric) reformats of thoracic and upper abdominal tissue movement during incremental closed chest compression/decompression from 0 to 8 to 0 cm. METHODS Sequential angiography enhanced computed tomography (CT) scans were acquired from a recently deceased, consented adult cadaver with 1 cm incremental closed chest compression/decompression. Three compression/decompression sequences from 0 to 3 cm, 0 to 5 cm, and 0 to 8 cm, respectively, were scanned using a radio-opaque, manually operated, chest compression device. The multiphase volumetric data sets were compiled into 4D models that allowed for multiplanar reformatted and volume rendered image manipulation. RESULTS Time-resolved volumetric (4D) models were produced using freeware to post-process the static CT scans. The 4D models allowed the study of simulated thoracic and upper abdominal content movement during closed chest compression. CONCLUSIONS The method described could assist CPR researchers and educators in the development and demonstration of effective CPR protocols.
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Affiliation(s)
- Kasper Hansen
- Department of Forensic Medicine, Aarhus University, DK-8200 Aarhus N, Denmark; Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Zoophysiology, Department of Biology, Aarhus University, C. F. Møllers Allé 3, DK-8000 Aarhus C, Denmark; University of Leicester, East Midlands Forensic Pathology Unit, Robert Kilpatrick Building, Level, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Ruth Machin
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Jonathon James
- Imaging Department, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Timothy Coats
- University of Leicester, Cardiovascular Sciences, Jarvis Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Guy N Rutty
- University of Leicester, East Midlands Forensic Pathology Unit, Robert Kilpatrick Building, Level, Leicester Royal Infirmary, Leicester LE2 7LX, UK.
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Salerno A, Euerle BD, Witting MD. Transesophageal Echocardiography Training of Emergency Physicians Through an E-Learning System. J Emerg Med 2020; 58:947-952. [PMID: 32362376 DOI: 10.1016/j.jemermed.2020.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Transesophageal echocardiography (TEE) has been shown to be a powerful tool that emergency physicians can use to guide resuscitation efforts during cardiac arrest. Currently, there is no standardized curriculum to teach TEE to emergency physicians. OBJECTIVE We hypothesized that the use of a pilot training course combining interactive e-learning and hands-on simulation would increase the percentage of students achieving a score of ≥80% on a multiple-choice test of knowledge and increase self-reported comfort using TEE. METHODS We designed a 2.5-h TEE course for emergency physicians and medical intensive care unit fellows. Participants took a test of knowledge and a survey of comfort-both online-before, just after, and 4 weeks after taking the course. Survey responses measured participants self-reported comfort with using TEE in clinical practice. A normal binomial approximation was used to calculate the 95% confidence interval. RESULTS Of the 3 tests of knowledge, 15 participants completed all tests. Of the surveys of comfort, 31 participants completed the precourse survey, 32 completed the postcourse survey, and 19 completed the 4-week follow-up survey. The proportion of students scoring ≥80% improved from 40% on the precourse test to 80% on the postcourse test (95% confidence interval 1-79). The proportion of students indicating comfort with using TEE improved from 3% precourse to 53% postcourse (95% confidence interval 28-71). CONCLUSIONS A TEE training course resulted in a 50% increase in surveyed participants feeling comfortable using TEE in cardiac arrest and a 40% increase in participants scoring ≥80% on a test of knowledge.
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Affiliation(s)
- Alexis Salerno
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brian D Euerle
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael D Witting
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Shiber J, Fontane E, Newberry M. Transesophageal Echocardiography Use During Cardiopulmonary Resuscitation. Ann Emerg Med 2020; 74:823. [PMID: 31779960 DOI: 10.1016/j.annemergmed.2019.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Mark Newberry
- Department of Emergency Medicine, Mt Sinai Medical Center, Miami, FL
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Wedin JO, Kristófi R, Ölander CH, Grinnemo KH. Cardiac Arrest after a Transatlantic Flight in a Patient with a Large Left Atrial Myxoma. ACTA ACUST UNITED AC 2020; 4:28-32. [PMID: 32099941 PMCID: PMC7026534 DOI: 10.1016/j.case.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac myxoma is the most common benign primary cardiac tumor. Cardiac myxomas can cause a variety of symptoms from dyspnea to cardiac arrest. Echocardiography plays an essential role in the diagnosis of cardiac myxomas. Prompt surgical excision is the gold standard treatment of cardiac myxomas. Air-travel predispose for cardiac decompensation in several heart conditions. We describe a case of cardiac decompensation in a patient with a cardiac myxoma.
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Affiliation(s)
- Johan O Wedin
- Department of Surgical Sciences, Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden
| | - Robin Kristófi
- Department of Medical Sciences, Emergency Care, Uppsala University Hospital, Uppsala, Sweden
| | - Carl-Henrik Ölander
- Department of Surgical Sciences, Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden
| | - Karl-Henrik Grinnemo
- Department of Surgical Sciences, Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden
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Hussein L, Rehman MA, Sajid R, Annajjar F, Al-Janabi T. Bedside ultrasound in cardiac standstill: a clinical review. Ultrasound J 2019; 11:35. [PMID: 31889224 PMCID: PMC6937355 DOI: 10.1186/s13089-019-0150-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/23/2019] [Indexed: 01/11/2023] Open
Abstract
Patients with cardiac arrest present as a relatively frequent occurrence in the Emergency Department. Despite the advances in our understanding of the pathophysiology of cardiac arrest, managing the condition remains a stressful endeavor and currently implemented interventions, while beneficial, are still associated with a disappointingly low survivability. The majority of modern Advanced Life Support algorithms employ a standardized approach to best resuscitate the 'crashed' patient. However, management during resuscitation often encourages a 'one-size-fits-all' policy for most patients, with lesser attention drawn towards causality of the disease and factors that could alter resuscitative care. Life support providers are also often challenged by the limited bedside predictors of survival to guide the course and duration of resuscitation. Over the recent decades, point-of-care ultrasonography (PoCUS) has been gradually proving itself as a useful adjunct that could potentially bridge the gap in the recognition and evaluation of precipitants and end-points in resuscitation, thereby facilitating an improved approach to resuscitation of the arrested patient. Point-of-care ultrasound applications in the critical care field have tremendously evolved over the past four decades. Today, bedside ultrasound is a fundamental tool that is quick, safe, inexpensive and reproducible. Not only can it provide the physician with critical information on reversible causes of arrest, but it can also be used to predict survival. Of note is its utility in predicting worse survival outcomes in patients with cardiac standstill, i.e., no cardiac activity witnessed with ultrasound. Unfortunately, despite the increasing evidence surrounding ultrasound use in arrest, bedside ultrasound is still largely underutilized during the resuscitation process. This article reviews the current literature on cardiac standstill and the application of bedside ultrasound in cardiac arrests.
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Affiliation(s)
| | | | - Ruhina Sajid
- Mediclinic Hospital, Dubai, United Arab Emirates
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Aiping Y, Shuangyin Z, Yanhong X, Rongzhi Z. Management of intraoperative acute pulmonary embolism in a patient with subarachnoid haemorrhage undergoing femoral fracture repair. J Int Med Res 2019; 47:5307-5311. [PMID: 31552755 PMCID: PMC6833381 DOI: 10.1177/0300060519874158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Acute pulmonary embolism (APE) during surgery can be life-threatening. We herein
report a case of a 56-year-old man with subarachnoid haemorrhage who underwent
surgical repair of a femoral fracture. During surgery with the patient under
general anaesthesia, his oxygen saturation and end-tidal carbon dioxide
decreased dramatically. An emergency transoesophageal echocardiogram
demonstrated mobile echogenic densities in the right pulmonary artery and
enlargement of the right atrium, and these findings were suggestive of APE.
Considering the patient’s history of subarachnoid haemorrhage, anticoagulation
with heparin or thrombolysis therapy for APE was contraindicated. We recommended
inferior vena cava filter placement to prevent recurrence of the APE.
Unfortunately, the patient and his family members refused the filter
implantation, and the patient was discharged.
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Affiliation(s)
- Yang Aiping
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhang Shuangyin
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xing Yanhong
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhang Rongzhi
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
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Resuscitative Cardiopulmonary Ultrasound and Transesophageal Echocardiography in the Emergency Department. Emerg Med Clin North Am 2019; 37:409-430. [PMID: 31262412 DOI: 10.1016/j.emc.2019.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Resuscitative ultrasound describes point-of-care applications that provide diagnostic information, physiologic monitoring, and procedural guidance in critically ill patients. This article reviews the evaluation of ventricular function, identification of pericardial effusion and tamponade, evaluation of preload and fluid responsiveness, and hemodynamic monitoring, as some of the main applications where this modality can help emergency physicians during resuscitation of critically ill patients.
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Parker BK, Salerno A, Euerle BD. The Use of Transesophageal Echocardiography During Cardiac Arrest Resuscitation: A Literature Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1141-1151. [PMID: 30280396 DOI: 10.1002/jum.14794] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
We propose that transesophageal echocardiography (TEE) can be used to guide cardiac arrest resuscitation. We undertook a literature search (Medline and EMBase) to assess articles on that topic. Our search yielded 55 articles falling into 3 categories: TEE used in operating rooms, TEE used in emergency departments, and TEE used in other settings. In many cases, TEE changed the direction of the resuscitation; however, it is unclear whether TEE changed patient-oriented outcomes, such as neurologically intact survival. Few adverse events related to TEE have been documented. There is growing evidence that physicians can learn to use TEE during resuscitations and apply the findings to clinical decisions.
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Affiliation(s)
- Brian K Parker
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Alexis Salerno
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Brian D Euerle
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Izumi Y, Ishihara S, Cammack I, Miyawaki I. Massive mass embolism detected by transesophageal echocardiography in bone cement implantation syndrome: a case report. JA Clin Rep 2019; 5:5. [PMID: 32026061 PMCID: PMC6967219 DOI: 10.1186/s40981-019-0225-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/16/2019] [Indexed: 12/02/2022] Open
Abstract
Bone cement implantation syndrome (BCIS) is a known complication in patients undergoing cemented orthopedic surgeries; however, the etiology and pathophysiology of BCIS are not fully understood. We report the case of a patient who developed pulseless electrical activity (PEA) due to BCIS after cemented femoral head replacement. Transesophageal echocardiography (TEE) during PEA revealed a massive embolus extending from the main pulmonary artery to the inferior vena cava. Of note, this embolus disappeared completely and rapidly after return of spontaneous circulation. TEE proved to be useful in the diagnosis and management of this case of PEA.
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Affiliation(s)
- Yuki Izumi
- Department of Anesthesiology and Critical Care, Teine Keijinkai Hospital, 006-0085 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan.
| | - Satoshi Ishihara
- Department of Anesthesiology and Critical Care, Teine Keijinkai Hospital, 006-0085 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Ivor Cammack
- Department of Clinical Residency, Teine Keijinkai Hospital, 006-0085, 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Ikuko Miyawaki
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 650-0047, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan
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Lau V, Priestap F, Landry Y, Ball I, Arntfield R. Diagnostic Accuracy of Critical Care Transesophageal Echocardiography vs Cardiology-Led Echocardiography in ICU Patients. Chest 2018; 155:491-501. [PMID: 30543807 DOI: 10.1016/j.chest.2018.11.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Critical care transesophageal echocardiography (ccTEE) performed by intensivists is increasingly used to investigate cardiorespiratory failure in the ICU. Validation of the accuracy of TEE in the hands of intensivists remains largely unknown. The goal of this study was to characterize the diagnostic accuracy of ccTEE. METHODS This study was a two-center, retrospective comparison between TEE studies performed and interpreted by intensivists and cardiology-led TEE or transthoracic echocardiography (TTE) performed and/or interpreted by cardiologists. The study period was December 2012 to December 2016 for all consecutive ICU patients who received an initial ccTEE and either a cardiology TEE or TTE within 72 h. Using the cardiology-conducted examination as the gold standard, we reported sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ccTEE. RESULTS Comparisons between ccTEE and cardiology TEE/TTE performed yielded 56 patients (five ccTEE vs cardiology TEE and 51 ccTEE vs cardiology TTE). The comparison between ccTEE and cardiology TEE showed 100% sensitivity, specificity, PPV, NPV, and accuracy for the primary diagnosis and other major findings. For the combined ccTEE and cardiology TEE/TTE comparison, there was a high sensitivity/specificity/PPV/NPV/accuracy for the primary diagnosis (90%-100% range), as well as other major diagnoses (88%-100% range). CONCLUSIONS This study showed that ccTEE has a high sensitivity, specificity, PPV, NPV, and accuracy compared with the gold standard cardiology TEE or TTEs in critically ill patients, when performed by advanced echocardiogram-trained/experienced intensivists.
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Affiliation(s)
- Vincent Lau
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Fran Priestap
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Yves Landry
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ian Ball
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Robert Arntfield
- Department of Medicine, Division of Critical Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Abstract
The care for victims of out-of-hospital cardiac arrest is evolving and will be influenced by future and emerging technologies that will play a role in the systems of care for these patients. Recent advances in extracorporeal life support and point-of-care ultrasound imaging, both in-hospital and out-of-hospital, may offer a therapeutic solution in some systems for patients with refractory or recurrent cardiac arrest. Drones capable of delivering automated external defibrillators to the scene of an out-of-hospital cardiac arrest, advances in digital and mobile technologies to notify and leverage bystander response, and wearable life detection technologies may improve survival.
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Affiliation(s)
- Andrew J Latimer
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
| | - Andrew M McCoy
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
| | - Michael R Sayre
- Department of Emergency Medicine, University of Washington, Box 359727, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Fire Department, Box 359702, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
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Letter to the Editor regarding recent Heart and Lung: The Journal of Acute and Critical Care article "Intramural atrial hematoma complicating transesophageal echocardiography during cardiac arrest" by Marchandot et al. Heart Lung 2018; 47:434. [PMID: 29724612 DOI: 10.1016/j.hrtlng.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022]
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In reply:. Ann Emerg Med 2018; 71:543-544. [DOI: 10.1016/j.annemergmed.2017.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 11/17/2022]
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Aagaard R, Løfgren B, Grøfte T, Sloth E, Nielsen RR, Frederiksen CA, Granfeldt A, Bøtker MT. Timing of focused cardiac ultrasound during advanced life support – A prospective clinical study. Resuscitation 2018; 124:126-131. [DOI: 10.1016/j.resuscitation.2017.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/24/2017] [Accepted: 12/10/2017] [Indexed: 11/25/2022]
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Hempel D, Pfister R, Michels G. Strukturierte bettseitige Sonographie in der Intensivmedizin. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-017-0201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Transesophageal Echocardiography: Guidelines for Point-of-Care Applications in Cardiac Arrest Resuscitation. Ann Emerg Med 2018; 71:201-207. [DOI: 10.1016/j.annemergmed.2017.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/26/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022]
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Long B, Alerhand S, Maliel K, Koyfman A. Echocardiography in cardiac arrest: An emergency medicine review. Am J Emerg Med 2017; 36:488-493. [PMID: 29269162 DOI: 10.1016/j.ajem.2017.12.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Cardiac arrest management primarily focuses on optimal chest compressions and early defibrillation for shockable cardiac rhythms. Non-shockable rhythms such as pulseless electrical activity (PEA) and asystole present challenges in management. Point-of-care ultrasound (POCUS) in cardiac arrest is promising. OBJECTIVES This review provides a focused assessment of POCUS in cardiac arrest, with an overview of transthoracic (TTE) and transesophageal echocardiogram (TEE), uses in arrest, and literature support. DISCUSSION Cardiac arrest can be distinguished between shockable and non-shockable rhythms, with management varying based on the rhythm. POCUS provides a diagnostic and prognostic tool in the emergency department (ED), which may improve accuracy in clinical decision-making. Several protocols incorporate POCUS based on different cardiac views. TTE includes parasternal long axis, parasternal short axis, apical 4-chamber, and subxiphoid views, which may be used in cardiac arrest for diagnosis of underlying cause and potential prognostication. TEE is conducted by inserting the probe into the esophagus of intubated patients, with several studies evaluating its use in cardiac arrest. It is associated with few adverse effects, while allowing continued compressions (and evaluation of those compressions) and not interrupting resuscitation efforts. CONCLUSIONS POCUS is a valuable diagnostic and prognostic tool in cardiac arrest, with recent literature supporting its diagnostic ability. TTE can guide resuscitation efforts dependent on the rhythm, though TTE should not interrupt other resuscitation measures. TEE can be useful during arrest, but further studies based in the ED are needed.
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Affiliation(s)
- Brit Long
- San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX, United States, 78234.
| | - Stephen Alerhand
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, United States.
| | - Kurian Maliel
- Wright Patterson Military Medical Center, Department of Cardiology, 4881 Sugar Maple Dr, Dayton, OH 45433, United States
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
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Dawkins Arce F, Berrío-Valencia MI. Ecocardiografía transesofágica de rescate: enfoque y futuro. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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41
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Dawkins Arce F, Berrío-Valencia MI. Rescue transesophageal echocardiography: Approach and future. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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42
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Rescue transesophageal echocardiography: Approach and future☆: Ecocardiografía transesofágica de rescate: enfoque y futuro. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712002-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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[Structured bedside-ultrasound in intensive care medicine]. Med Klin Intensivmed Notfmed 2017; 112:741-758. [PMID: 29063125 DOI: 10.1007/s00063-017-0366-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 12/27/2022]
Abstract
The so-called point-of-care ultrasound (POCUS) is of increasing importance for diagnostics and therapy control in intensive care medicine. Based on focused thorax sonography, echocardiography, and abdominal sonography, the most important working and differential diagnoses can be demonstrated or excluded depending on the leading symptom. Sonographic-based algorithms allow a structured evaluation especially of patients with the common leading symptoms dyspnea and thoracic pain.
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Feasibility, Safety, and Utility of Advanced Critical Care Transesophageal Echocardiography Performed by Pulmonary/Critical Care Fellows in a Medical ICU. Chest 2017; 152:736-741. [DOI: 10.1016/j.chest.2017.06.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/14/2017] [Accepted: 06/23/2017] [Indexed: 12/16/2022] Open
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45
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Byars DV, Tozer J, Joyce JM, Vitto MJ, Taylor L, Kayagil T, Jones M, Bishop M, Knapp B, Evans D. Emergency Physician-performed Transesophageal Echocardiography in Simulated Cardiac Arrest. West J Emerg Med 2017; 18:830-834. [PMID: 28874934 PMCID: PMC5576618 DOI: 10.5811/westjem.2017.5.33543] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/01/2017] [Accepted: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Transesophageal echocardiography (TEE) is a well-established method of evaluating cardiac pathology. It has many advantages over transthoracic echocardiography (TTE), including the ability to image the heart during active cardiopulmonary resuscitation. This prospective simulation study aims to evaluate the ability of emergency medicine (EM) residents to learn TEE image acquisition techniques and demonstrate those techniques to identify common pathologic causes of cardiac arrest. Methods This was a prospective educational cohort study with 40 EM residents from two participating academic medical centers who underwent an educational model and testing protocol. All participants were tested across six cases, including two normals, pericardial tamponade, acute myocardial infarction (MI), ventricular fibrillation (VF), and asystole presented in random order. Primary endpoints were correct identification of the cardiac pathology, if any, and time to sonographic diagnosis. Calculated endpoints included sensitivity, specificity, and positive and negative predictive values for emergency physician (EP)-performed TEE. We calculated a kappa statistic to determine the degree of inter-rater reliability. Results Forty EM residents completed both the educational module and testing protocol. This resulted in a total of 80 normal TEE studies and 160 pathologic TEE studies. Our calculations for the ability to diagnose life-threatening cardiac pathology by EPs in a high-fidelity TEE simulation resulted in a sensitivity of 98%, specificity of 99%, positive likelihood ratio of 78.0, and negative likelihood ratio of 0.025. The average time to diagnose each objective structured clinical examination case was as follows: normal A in 35 seconds, normal B in 31 seconds, asystole in 13 seconds, tamponade in 14 seconds, acute MI in 22 seconds, and VF in 12 seconds. Inter-rater reliability between participants was extremely high, resulting in a kappa coefficient across all cases of 0.95. Conclusion EM residents can rapidly perform TEE studies in a simulated cardiac arrest environment with a high degree of precision and accuracy. Performance of TEE studies on human patients in cardiac arrest is the next logical step to determine if our simulation data hold true in clinical practice.
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Affiliation(s)
- Don V Byars
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - Jordan Tozer
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - John M Joyce
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - Michael J Vitto
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - Lindsay Taylor
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - Turan Kayagil
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - Matt Jones
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - Matthew Bishop
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - Barry Knapp
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - David Evans
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
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47
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Aagaard R, Caap P, Hansson NC, Bøtker MT, Granfeldt A, Løfgren B. Detection of Pulmonary Embolism During Cardiac Arrest—Ultrasonographic Findings Should Be Interpreted With Caution*. Crit Care Med 2017; 45:e695-e702. [DOI: 10.1097/ccm.0000000000002334] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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48
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 920] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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Phan KM, Lam PV, Kimura BJ. “Code Blue” in a 66-Year-Old Man in the Cardiology Department. Chest 2016; 150:e37-40. [DOI: 10.1016/j.chest.2016.02.689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/26/2016] [Accepted: 02/27/2016] [Indexed: 11/30/2022] Open
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50
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Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II. Crit Care Med 2016; 44:1206-27. [DOI: 10.1097/ccm.0000000000001847] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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