Document Detail

Diagnostic accuracy of transesophageal echocardiography during cardiopulmonary resuscitation.
MedLine Citation:
PMID:  9283540     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to establish the diagnostic accuracy of transesophageal echocardiography (TEE) during cardiopulmonary resuscitation. BACKGROUND: Because of its bedside diagnostic capabilities, excellent cardiac 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 patients with prolonged circulatory arrest. The TEE diagnoses were compared with diagnoses from autopsy, surgery and clinical follow-up. RESULTS: 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-hospital onset of arrest. Forty-four patients eventually died; four survived to discharge. The diagnoses made with TEE were cardiac tamponade (n = 6), myocardial infarction (n = 21), pulmonary embolism (n = 6), ruptured aorta (n = 1), aortic dissection (n = 4), papillary muscle rupture (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 was confirmed in 27 of the 31-by postmortem examination (n = 19), operation (n = 2), angiography (n = 2) or clinical course (n = 4). In the other four patients the TEE diagnosis proved incorrect by postmortem examination. The sensitivity, specificity and positive predictive value of TEE were 93%, 50% and 87%, respectively. In 15 patients (31%), major therapeutic decisions were based on TEE findings. CONCLUSIONS: TEE can reliably establish the cause of a circulatory arrest during cardiopulmonary resuscitation.
P A van der Wouw; R W Koster; B J Delemarre; R de Vos; A J Lampe-Schoenmaeckers; K I Lie
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  30     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1997 Sep 
Date Detail:
Created Date:  1997-09-18     Completed Date:  1997-09-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  780-3     Citation Subset:  AIM; IM    
Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
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MeSH Terms
Aged, 80 and over
Aortic Diseases / complications,  ultrasonography
Cardiac Tamponade / complications,  ultrasonography*
Cardiopulmonary Resuscitation*
Echocardiography, Transesophageal*
Heart Arrest / etiology*,  therapy,  ultrasonography
Heart Rupture / complications,  ultrasonography
Middle Aged
Myocardial Infarction / complications,  ultrasonography*
Predictive Value of Tests
Pulmonary Embolism / complications,  ultrasonography*
Sensitivity and Specificity

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