Role of Transesophageal Echocardiography in Differential Diagnosis of The Cause of Cardiac Arrest During The Secondary Survey of Advanced Cardiac Life Support

ABSTRACT

BACKGROUND: During the secondary survey of advanced cardiac life support (ACLS), differential diagnosis to seek the cause of cardiac arrest is an important step in patient who failed to restore spontaneous circulation after the primary survey and resuscitation. This study was to evaluate the role of transesophageal echocardiography (TEE) for assessing the cause of cardiac arrest during the secondary survey of ACLS. METHOD: We performed biplane TEE during cardiopulmonary resuscitation (CPR) in 52 consecutive patients (31 male, 21 female, mean age 58 years old) with cardiac arrest who failed to restore spontaneous circulation after the primary survey and resuscitation attempt. Initial presenting ECG rhythm was ventricular fibrillation in 7, asystole in 25, and pulseless electrical activity in 20 patients. TEE was performed immediately if spontaneous circulation was not restored after the primary survey and resuscitation. Possible causes of cardiac arrest were detected in 23 patients (44%) by TEE. Positive findings were observed in 3 (43%) of 7 patients with ventricular fibrillation, 12 (48%) of 25 patients with asystole, and 8 (40%) of 20 patients with pulseless electrical activity. TEE findings were as followings pericardial effusion in 10, aortic dissection in 5, occlusion of mitral orifice by a thrombus or a mass in 2, main pulmonary artery thrombus in 2, thrombotic occlusion of the prosthetic valve in 1, hypertrophic cardiomyopathy in 1, and aortic stenosis in 1. Interventions including pericardiocentesis (n=10) and emergency thoracotomy (n=1) were attempted during resuscitation. Spontaneous circulation was restored in 16 patients (31%). One patient was discharged alive. CONCLUSION: TEE is an useful diagnostic tool to identify the cause of cardiac arrest during the secondary survey of ACLS.