DIAGNOSTIC-ACCURACY OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING CARDIOPULMONARY-RESUSCITATION

Objectives. We sought to establish the diagnostic accuracy of transeso phageal echocardiography (TEE) during cardiopulmonary resuscitation. B ackground. Because of its bedside diagnostic capabilities, excellent c ardiac images and lack of interference with resuscitation efforts, TEE is ideally suited to determine the cause of a circulatory arrest that is not due to severe arrhythmia. However, the diagnostic accuracy of TEE during resuscitation is unknown. Methods. TEE was performed in pat ients with prolonged circulatory arrest. The TEE diagnoses were compar ed with diagnoses from autopsy, surgery and clinical follow-up. Result s. Of the 48 study patients (29 male, 19 female, mean age +/- SD 61 +/ - 20 years), 28 had an in-hospital cardiac arrest and 20 an out-of-hos pital onset of arrest. Forty-four patients eventually died; four survi ved to discharge. The diagnoses made with TEE were cardiac tamponade ( n = 6), myocardial infarction (n = 21), pulmonary embolism (n = 6), ru ptured aorta (n = I), aortic dissection (n = 4), papillary muscle rupt ure (n = 1), other diagnosis (n = 2) and absence of structural cardiac abnormalities (n = 7). A definite diagnosis from a reference standard was available in 31 patients, The TEE diagnosis mas confirmed in 27 o f the 31-by postmortem examination (n = 19), operation (n = 2), angiog raphy (n = 2) or clinical course (n = 4). In the other four patients t he TEE diagnosis proved incorrect by postmortem examination. The sensi tivity, specificity and positive predictive value of TEE were 93%, 50% anti 87%, respectively. In 15 patients (31%), major therapeutic decis ions were based on TEE findings. Conclusions. TEE can reliably establi sh the cause of a circulatory arrest during cardiopulmonary resuscitat ion. (C) 1997 by the American College of Cardiology.