Carta Revisado por pares

Echocardiographic observations during in-hospital cardiopulmonary resuscitation

2006; Elsevier BV; Volume: 71; Issue: 2 Linguagem: Inglês

10.1016/j.resuscitation.2006.07.015

ISSN

1873-1570

Autores

Manuel Ruiz-Bailén, Antonia Morante-Valle, Ana María Castillo-Rivera, Antonio Pintor‐Mármol, José Ángel Ramos-Cuadra, Manuela Expósito Ruíz, Francisco Brea-Salvago,

Tópico(s)

Hemodynamic Monitoring and Therapy

Resumo

Cardiac arrest is normally managed by using the guidelines approved by the ERC.1de Latorre F. Nolan J. Robertson C. Chamberlain D. Baskett P. European Resuscitation CouncilEuropean Resuscitation Council guidelines 2000 for adult advanced life support. A statement from the Advanced Life Support Working Group (1) and approved by the Executive Committee of the European Resuscitation Council.Resuscitation. 2001; 48: 211-221Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar However, there may be situations where non-standard methods should be used. Transthoracic (TTE) or transoesophageal (TEE) echocardiography has been observed as an efficient measure in shock situations.2Jones A.E. Craddock P.A. Tayal V.S. Kline J.A. Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension.Shock. 2005; 24: 513-517Crossref Scopus (91) Google Scholar, 3Cheitlin M. Alpert J. Armstrong W. et al.ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiolgoy/American Heart Association Task Force on Practice Guidelines (Committee en Clinical Application of Echocardiography). Developed in Collaboration With the American Society of Echocardiography.Circulation. 1997; 95: 1686-1744Crossref PubMed Scopus (599) Google Scholar The aim of this letter is to describe the performance of TTE/TEE while cardiopulmonary resuscitation (CPR) is being carried out. We have used a methodological study backed by a descriptive, retrospective study. The study period was between February 2003 and September 2005. During this period 32 TTE/TEE were performed on patients during cardiopulmonary resuscitation (CPR) (without a previous diagnosis). The qualitative impact on the modification of diagnosis and therapy was analysed. The TTE/TEE was performed without interfering with the CPR, always beginning transthoracically and introducing the transoesophageal probe after having carried out orotracheal intubation. During this study period, we obtained the following results. Seventy-six patients admitted to intensive care unit and emergency room due to cardiac arrest (CA) of unknown cause were included. No diagnosis was found with the echocardiogram to explain the cardiac arrest in 44 patients. 63.15% were male. The median age was 74, range 65 years. In the 32 patients with echocardiographic findings, the following features were observed:(1)Cardiac tamponade was detected in four patients, all four being drained, although only two patients (one with cardiac rupture) and another with tamponade had a spontaneous return of circulation.(2)Two type A aortic aneurisms.(3)Papillary rupture (see Figure 1).(4)Two patients with dynamic hypertrophic obstructive cardiomyopathy who also had spontaneous return of pulse.(5)Six patients with dilated cardiomyopathy.(6)One patient with spongiform cardiomyopathy (diagnosed by endomyocardial biopsy after failed CPR).(7)Three patients with aortic disease (one with severe aortic stenosis) and two patients with severe aortic insufficiency.(8)Twelve patients were diagnosed with pulmonary thromboembolism (PTE), four patients with a certain diagnosis (intracavity thrombus) and eight with indirect data, all being treated with systemic thrombolysis—eight patients had a return of a spontaneous pulse.(9)One patient with a cardiac mass (diagnosis by endomyocardial biopsy were rhabdomyosarcoma). In this study, a clear benefit was observed in the use of diagnostic echocardiography during CPR in providing a diagnosis which could modify the management without interfering with the CPR. The findings suggested by our study have been supported by other authors4Klouche K. Weil M.H. Sun S. Tang W. Kamohara T. Echo-Doppler observations during cardiac arrest and cardiopulmonary resuscitation.Crit Care Med. 2000; 28: N212-N213Crossref Scopus (18) Google Scholar, 5Varriale P. Maldonado J.M. Echocardiographic observations during in hospital cardiopulmonary resuscitation.Crit Care Med. 1997; 25: 1717-1720Crossref PubMed Scopus (89) Google Scholar; however, each one has a serious bias, since they are either retrospective, or not controlled. In short, it would be very useful to carry out a controlled study to evaluate the effectiveness of echocardiography during CPR. We conclude that TTE/TEE can be a useful tool during CPR, providing diagnostic information which might modify the therapeutic algorithms in advanced CPR.

Referência(s)
Altmetric
PlumX