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Diagnosis of aortic dissection by transesophageal echocardiography during cardiopulmonary resuscitation

Published:January 16, 2020DOI:https://doi.org/10.1016/j.ajem.2020.01.026

      Highlights

      • TEE allows aortic dissection diagnosis as a cause of cardiac arrest during CPR.
      • Aortic dissection is associated with poor resuscitation outcome.
      • Diagnosis of aortic dissection helps to determine treatment modality.

      Abstract

      Objectives

      Early identification of the causes of cardiac arrest is helpful in determining the resuscitation measures during cardiopulmonary resuscitation (CPR). We aimed to evaluate the feasibility of transesophageal echocardiography (TEE) during CPR in diagnosing aortic dissection and the influence of aortic dissection on resuscitation outcome in adult patients with prolonged non-traumatic cardiac arrest.

      Methods

      Adult patients aged >20 years with non-traumatic cardiac arrest who underwent prolonged CPR (>10 min) and TEE examination during CPR were enrolled. The enrolled patients were grouped according to the presence of aortic dissection on TEE: the aortic dissection (AD) group and the non-AD group. Variables related to cardiac arrest event, CPR, and resuscitation outcome were compared between the two groups.

      Results

      Forty-five patients (median age, 71 years; 26 men) were enrolled. Ten (22.2%) and 35 (77.8%) patients were included in the AD and non-AD groups, respectively. No patients in the AD group survived. Aortic dissection on TEE was inversely related to the rate of return of spontaneous circulation on multivariate analysis (odds ratio, 0.019; 95% confidence interval, 0.001–0.750; p = .035).

      Conclusion

      TEE is a useful tool for diagnosing aortic dissection as a cause of cardiac arrest during CPR. Aortic dissection is associated with poor resuscitation outcomes.

      Abbreviations:

      AD (aortic dissection), CPR (cardiopulmonary resuscitation), ED (emergency department), OR (odds ratio), POC (point-of-care), TEE (transesophageal echocardiography), TTE (transthoracic echocardiography)

      Keywords

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