Abstract Body: Background: Resuscitative Transesophageal Echo (rTEE) may enhance CPR quality and identify reversible causes impacting survival.
Hypothesis: We hypothesized that sonographic CPR phenotypes may serve as targets for interventions. We aimed to observe CPR under rTEE to identify targets to improve outcomes.
Methods: This retrospective study from 2019 to 2023 enrolled Emergency Department cardiac arrests (EDCA) that underwent rTEE. Reviewers extracted Utstein core and supplemental variables and rTEE clips representing 6-second epochs. We categorized mid esophageal long axis (MELA) cardiac views during CPR epochs for interpretability, aortic valve opening (AVO) during CPR systole and CPR diastole, aortic root compression, and ventricular fibrillation. We categorized epochs as synchronous CPR (AV opens during CPR systole), or asynchronous CPR (AV opens during CPR diastole). We calculated the proportion of AVOs per CPR thrust during synchronous and asynchronous CPR. Interpretability of right heart and aortic windows were noted. Two reviewers co-read a sample to determine agreement. Descriptive statistics describe results.
Results: Among 69 EDCAs, 66% were male with a median weight of 79kg (IQR, 68-100). EMS reported 59 (86%) initial non-shockable rhythms (NSR) and secured an airway in 48 (70%). Field ROSC was noted at least once in 23 (33%). At ED arrival, 46 (67%) had ongoing CPR, 28 with a CPR device (41%). ED ROSC was achieved at least once in 41 (59%). In total, 21 (30%) survived to hospital admission and 4 (6%) to hospital discharge. We observed no cases of pulmonary emboli or aortic syndrome on rTEE. Reviewers judged 31(28%) right ventricular inflow-outflow views and 15 (22%) aortic arch views interpretable. We captured 971 epochs with rTEE during EDCA. Aortic root compression was noted in 35 (26%, 95% CI 20-34) cases. From 30 subjects (43%) we recorded 133 MELA windows during CPR and 96 (72%, 95% CI 64-79 ) were adequate to assess AVO. Synchronous AVO was noted in 43 (33%, 95% CI 26-41) and asynchronous AVO was noted in 26 (20%, 95% CI 13-27). AVO frequency during synchronous CPR was 85% (95%CI, 81-98) and 66% (95%CI, 60-71) during asynchronous CPR. Ventricular fibrillation was identified in 2 cases (3%, 95% CI, 1-10). Kappa between two reviewers was substantial (0.70).
Conclusion: The proportion of inadequate views during CPR is high. Aortic root compression, synchronous and asynchronous CPR represent potential targets for improving CPR quality with rTEE.