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Resuscitative transoesophageal echocardiography performed by emergency physicians in the emergency department - insights from a one-year period.

OBJECTIVE
Transoesophageal echocardiography (TOE) has increasingly been described as a possible complementary and point-of-care approach for patients with cardiac arrest (CA). It provides information about potentially reversible causes, prognosis and allows monitoring of resuscitation efforts without affecting ongoing chest compressions. The aim of this study was to assess the feasibility of TOE performed by emergency physicians (EP) during CA in an emergency department (ED).


METHODS
This prospective study was performed at the Department of Emergency Medicine at the Medical University of Vienna from 02/2020 to 02/2021. All patients ≥18 years old presenting with ongoing resuscitation efforts were screened. After exclusion of potential contraindications, a TOE exam was performed and documented by EPs according to a standardized 4-view imaging protocol. The primary endpoint represents feasibility defined as successful probe insertion and acquisition of interpretable images.


RESULTS
Of 99 patients with ongoing non-traumatic CA treated in the ED, a total of 62 patients were considered to be examined by TOE. The examination was feasible in 57 patients (92%) (female, 14 [25%], mean age 53 ± 13, witnessed collapse 48 [84%]). Within these, the examiners observed 51 major findings in 32 different patients (66%). In 21 patients (37%) these findings led to a direct change of therapy. In 18 patients (32%), the examiner found ventricular contractions without detectable pulse. No TOE-related complications were found.


CONCLUSION
Our findings suggest that EPs may be able to acquire and interpret TOE images in the majority of patients during cardiac arrest using a standardized 4-view imaging protocol.