Out-of-Hospital Transesophageal Echocardiogram for Cardiac Arrest Resuscitation: The Initial Case.

Objective: The use of transesophageal echocardiogram (TEE) during cardiac arrest in the emergency department (ED) is a newer concept. TEE provides dynamic evaluation of chest compressions and rhythm analysis. Hand placement using external landmarks can result in maximal compression over the aorta, rather than the ventricles of the heart. Methods: We present the initial case of TEE performed in the out of hospital setting in an ambulance to facilitate cardiac arrest resuscitation using a disposable TEE probe. Results: This case is a proof of concept that TEE can be successfully performed and contribute to clinical care of cardiac arrest in the out of hospital setting. Conclusion: Further research needs to be performed to determine the clinical benefit, indications, and curriculum for emergency providers to successfully deliver this potentially valuable resource prior to widespread adoption.

The Effect of Furosemide Dose Administered in the Out-of-hospital Setting on Renal Function Among Patients with Suspected Acute Decompensated Heart Failure.

BACKGROUND: The most effective dose of prehospital furosemide in acute decompensated heart failure (ADHF) has not yet been identified and concerns of worsening renal function have limited its use. OBJECTIVE: To assess if administering high-dose furosemide is associated with worsening renal function. METHODS: The authors conducted a 2-center chart review for patients who presented via a single Emergency Medical Service (EMS) from June 5, 2009 through May 17, 2013. Inclusion criteria were shortness of breath, primarily coded as ADHF, and the administration of furosemide prior to emergency department (ED) arrival. A total of 331 charts were identified. The primary endpoint was an increase in creatinine (Cr) of more than 0.3 mg/dL from admission to any time during hospital stay. Exploratory endpoints included survival, length-of-stay (LOS), disposition, urine output in the ED, change in BUN/Cr from admission to discharge, and change in Cr from admission to 72 hours and discharge. RESULTS: When treated as a binary variable, there was no association observed between an increase in Cr of more than 0.3 mg/dL and prehospital furosemide dose. Baseline characteristics found to be associated with dose were included in the logistic regression model. Lowering the dose of prehospital furosemide was associated with higher odds of attaining a 0.3 mg/dL increase in Cr (adjusted OR = 1.49 for a 20 mg decrease; P = .019). There was no association found with any of the exploratory endpoints. CONCLUSIONS: Patients who received higher doses of furosemide prehospitally were less likely to have an increase of greater than 0.3 mg/dL in Cr during the hospital course.