CHEST Guidelines-A-Case-for-the-Use-of-Transesophageal-Echocardiogr

A-Case-for-the-Use-of-Transesophageal-Echocardiogr

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The article discusses the utilization of transesophageal echocardiography (TEE) in the emergency department (ED) to manage cardiac arrest effectively, particularly in detecting acute type A aortic dissection (AADA) and cardiac tamponade. The case discussed involves a 59-year-old man who presented with an out-of-hospital cardiac arrest and was found to have a non-ST-elevation myocardial infarction. Using point-of-care ultrasound (POCUS) and TEE, doctors identified a moderate circumferential pericardial effusion indicative of tamponade physiology, leading to a pericardiocentesis procedure. This intervention resulted in the return of spontaneous circulation (ROSC) and brought up suspicion of an AADA, which was confirmed by TEE.<br /><br />Key points in the management were early use of POCUS and TEE, which provided crucial information guiding resuscitation efforts. The timely pericardiocentesis procedure relieved the cardiac tamponade, and subsequent rapid diagnosis of AADA facilitated urgent surgical intervention, ultimately saving the patient's life. The patient underwent successful surgical repair and was discharged neurologically intact, underscoring the importance of these modalities in the ED setting.<br /><br />The article suggests TEE offers significant advantages: it can evaluate the quality of chest compressions, minimize interruptions during CPR, and assist in diagnosing conditions that might be challenging without CT scanning. Moreover, the use of TEE has been associated with impactful changes in patient management, including decisions regarding CPR and hemodynamic support. While TEE is traditionally performed by cardiologists, its growing adoption by trained emergency physicians helps expedite patient care, especially in cases with undiagnosed cardiac arrests. The article supports the potential for broader use of TEE in the ED to enhance emergency cardiovascular care and improve patient outcomes.

Keywords

transesophageal echocardiography

TEE

emergency department

cardiac arrest

aortic dissection

cardiac tamponade

point-of-care ultrasound

pericardiocentesis

resuscitation

emergency cardiovascular care