Background: Minimizing compression pauses during cardiopulmonary resuscitation (CPR) reduces total ischemic time and contributes to better outcomes. Guidelines suggest considering ultrasound when available to guide resuscitation management in cardiac arrest and identify cardiac motion. Due to availability and ease of use, transthoracic echocardiography (TTE) is most often employed in cardiac arrest, but requires space on the patient’s chest and clear images can be difficult to obtain.
Hypothesis: We hypothesized that transesophageal echocardiography (TEE), due to its superior image quality and lack of interference with compressions, may allow for shorter pulse check times.
Methods: We analyzed a cohort of sequential cardiac arrests treated in the emergency department of a major tertiary care hospital utilizing video recordings of resuscitation attempts. The duration of each pulse check was recorded by blinded reviewers as well as whether TTE, TEE, or no ultrasound was concomitantly employed. A mixed effects linear regression model was used to estimate the average pause time of pulse checks, accounting for the repeated measures design while controlling for victim body mass index.
Results: A total of 23 cardiac arrest victims were included in the analysis providing 208 pulse checks for analysis. Mean age of victims was 56 years and 42% were female. The mean pulse check duration for palpation alone, TTE, and TEE was 15 sec (95% CI 10-20), 23 sec (95% CI 16-30), and 12 sec (95% CI 7-18), respectively (P 0.00, 0.013, 0.00). TEE was associated with significantly shorter pulse check times when compared to TTE and palpation alone, although the latter difference was not statistically significant (FIGURE).
Conclusion: In this observational study, pulse check duration was significantly shorter when using TEE during CPR when compared to TTE but not to palpation alone. This factor should be taken into consideration when deciding ultrasound modalities during resuscitation.