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Copyright © 2022 The Korean Society of Emergency Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING
None.
AUTHOR CONTRIBUTIONS
Conceptualization: SOH; Data curation: WJJ; Investigation: KCC; Methodology: SOH; Resources: WJJ; Supervision: SOH; Visualization: YIR; Writing–original draft: SOH; Writing–review & editing: all authors.
All authors read and approved the final manuscript.
| Study | Study type | No. of patientsa) | Indication/objectiveb) | Main echocardiographic finding |
|---|---|---|---|---|
| Higano et al. [5] (1990) | Case report | 2 | Exploratory | Compression of RV and LV and closure of MV during compression |
| Kuhn et al. [6] (1991) | Case report | 1 | Exploratory | Opening of AV during thoracic compression with simultaneous closure of mitral and tricuspid valves |
| Porter et al. [7] (1992) | Prospective observational | 17 | Exploratory | Closure of MV during downstroke of chest compression and absence of correlation between MV flow and LV fractional shortening |
| Redberg et al. [8] (1993) | Prospective observational | 20 | Exploratory | MV opening during cardiac release, reduction of ventricular cavity size with compression, and atrioventricular regurgitation supporting the cardiac pump theory |
| Tucker et al. [9] (1993) | Prospective observational | 5 | Exploratory | Improved transmitral flow, end-decompression LV volume, and stroke volume with ACD CPR |
| Barton et al. [10] (1994) | Case report | 1 | Diagnostic | Massive pulmonary embolism as a cause of PEA |
| Ma et al. [11] (1994) | Case report | 1 | Complications | AV disruption complicating CPR |
| Pell et al. [12] (1994) | Prospective observational | 18 | Exploratory | Compression of all four cardiac chambers resulting in forward flow in pulmonary and systemic circulations, retrograde pulmonary vein flow, and incomplete MV closure |
| Antegrade pulmonary vein flow and LV filling observed during relaxation phase | ||||
| Pell et al. [13] (1994) | Prospective observational | 7 | Exploratory | Improved right heart compression, antegrade blood flow patterns, and LV filling during ACD CPR |
| Ma et al. [14] (1995) | Prospective observational | 17 | Exploratory | Presence of opened MV with forward mitral flow and backward pulmonary venous flow during chest compression, suggesting “LA pump” |
| Gilon et al. [15] (1996) | Case report | 1 | Exploratory | RV compression and tricuspid valve closure |
| Huemer et al. [16] (1996) | Case report | 1 | Exploratory | Closure of MV, opening of AV, and reduction of LV cross-sectional area during downstroke of chest compression |
| Van der Wouw et al. [17] (1997) | Prospective observational | 48 | Diagnostic | 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) |
| Hwang et al. [18] (1998) | Prospective observational | 52 | Diagnostic | Pericardial effusion (n = 10), aortic dissection (n = 5), occlusion of the mitral orifice by thrombus (n = 2), main pulmonary artery thrombus (n = 2), thrombotic occlusion of the prosthetic valve (n = 1), hypertrophic cardiomyopathy (n = 1), and aortic stenosis (n = 1) |
| Tsai et al. [19] (1999) | Case report | 1 | Diagnostic | Total tricuspid valve obstruction and massive pulmonary embolism |
| Comess et al. [20] (2000) | Prospective observational | 36 | Diagnostic | Pulmonary emboli in 9 of 25 patients (36%) with pulseless electrical activity as initial event |
| Hwang et al. [21] (2001) | Prospective observational | 14 | Exploratory | Deformation of the aorta at maximal compression site and increase in cross-sectional area of proximal aorta |
| Liu et al. [22] (2002) | Prospective observational | 6 | Exploratory | Closure of mitral and tricuspid valves with simultaneous opening of AV during chest compression |
| Memtsoudis et al. [23] (2006) | Retrospective observational | 22 | Exploratory | Thromboembolic events (n = 9), acute myocardial ischemia (n = 6), hypovolemia (n = 2), and pericardial tamponade (n = 2) |
| Lin et al. [24] (2006) | Prospective observational | 10 | Diagnostic | Myocardial infarction (n = 5), pulmonary embolism (n = 2), and severe hypovolemia and ventricular arrhythmia without specific pathology (n = 2) |
| Blaivas [25] (2008) | Case report | 6 | Diagnostic/monitoring | Identification of VF in patients with asystole on ECG |
| Kim et al. [26] (2008) | Prospective observational | 10 | Exploratory | Retrograde flow to LA and forward blood flow to aorta on LV contrast echocardiography during compression phase |
| Hwang et al. [27] (2009) | Prospective observational | 34 | Exploratory | Significant narrowing of LV outflow tract or aorta during compression phase |
| Weidman et al. [28] (2014) | Case report | 1 | Exploratory | Formation of multiple thrombi in heart and descending thoracic aorta during CA |
| Fair et al. [29] (2016) | Prospective observational | 10 | Guiding catheter cannulation | ECMO guidewire placement and cannula positioning |
| Liu et al. [30] (2016) | Prospective observational | 20 | Exploratory | Cardiac effect at beginning of CA, faded with time, making the thoracic pump dominant mechanism during prolonged CPR |
| Arntfield et al. [31] (2016) | Retrospective observational | 23 | Diagnostic/feasibility of TEE by emergency physicians | High degree of feasibility and clinical utility of ED-based TEE |
| Catena et al. [32] (2019) | Retrospective observational | 19 | Outcome prediction | LV outflow tract opening associated with successful CPR |
| Fair et al. [33] (2019) | Prospective interventional | 25 | Efficacy of TEE on pulse check time | Shorter pulse check times with TEE compared with TTE |
| Kim et al. [34] (2019) | Retrospective observational | 20 | Exploratory | Measurement of compression depth at RV free wall and calculation of compression velocity |
| Lee et al. [35] (2019) | Case report | 1 | Complications | Acute aortic dissection complicating CPR |
| Teran et al. [36] (2019) | Prospective observational | 21 | Diagnostic/CPR quality | Identification of pseudo-PEA and fine VF, determination of reversible pathology, and optimization of CPR quality |
| Giorgetti et al. [37] (2019) | Case report | 1 | Guiding catheterization | Monitoring of mechanical chest compression performance and guiding cannulation for ECPR |
| Long et al. [38] (2020) | Case report | 1 | Monitoring cardiac status | Monitoring of CA due to anaphylaxis |
| Merlin et al. [39] (2020) | Case report | 1 | Trial of out-of-hospital TEE | Report of initial case of out-of-hospital TEE |
| Jung et al. [40] (2020) | Retrospective observational | 158 | Diagnostic/prediction of outcome | Total of 40 patients (25.3%, TEE positive group) with specific TEE findings, including possible causes of CA (n = 31, 19.6%) and sequelae of CA (n = 9, 5.7%) |
| Positive TEE findings were associated with poor resuscitation outcomes | ||||
| Kim et al. [41] (2020) | Case report | 1 | Diagnostic | Paradoxical embolism of right heart thrombi visualized on TEE during CPR |
| Orihashi [42] (2020) | Case report | 4 | Guiding catheterization | Monitoring chest compressions, guiding catheter insertion, and assisting pericardiocentesis |
| Rublee et al. [43] (2020) | Case report | 1 | Diagnostic | Cardiac tamponade and type A aortic dissection |
| Kim et al. [44] (2021) | Retrospective observational | 45 | Diagnostic | Diagnosing aortic dissection as cause of CA |
| Poppe et al. [45] (2021) | Case report | 1 | Diagnostic | Massive intracardiac thrombus and subsequent thrombolysis |
| Horowitz et al. [46] (2021) | Case report | 1 | Diagnostic | Clot in transit in RA and thrombolysis |
| Jung et al. [47] (2022) | Retrospective observational | 97 | Evaluation of intracardiac shunt | Assessment for presence of right-to-left shunt during CPR |
TEE, transesophageal echocardiography; RV, right ventricle; LV, left ventricle; MV, mitral valve; AV, aortic valve; ACD, active compression decompression; CPR, cardiopulmonary resuscitation; PEA, pulseless electrical activities; LA, left atrium; VF, ventricular fibrillation; ECG, electrocardiogram; CA, cardiac arrest; ECMO, extracorporeal membrane oxygenation; ED, emergency department; TTE, transthoracic echocardiography; ECPR, extracorporeal cardiopulmonary resuscitation; RA, right atrium.
a)Number of patients only includes those who underwent TEE during CA.
b)Exploratory, determination of mechanism of blood flow during cardiopulmonary resuscitation; Diagnostic, diagnosis of cause of CA.
| Study | Study type | No. of patientsa) | Indication/objectiveb) | Main echocardiographic finding |
|---|---|---|---|---|
| Higano et al. [5] (1990) | Case report | 2 | Exploratory | Compression of RV and LV and closure of MV during compression |
| Kuhn et al. [6] (1991) | Case report | 1 | Exploratory | Opening of AV during thoracic compression with simultaneous closure of mitral and tricuspid valves |
| Porter et al. [7] (1992) | Prospective observational | 17 | Exploratory | Closure of MV during downstroke of chest compression and absence of correlation between MV flow and LV fractional shortening |
| Redberg et al. [8] (1993) | Prospective observational | 20 | Exploratory | MV opening during cardiac release, reduction of ventricular cavity size with compression, and atrioventricular regurgitation supporting the cardiac pump theory |
| Tucker et al. [9] (1993) | Prospective observational | 5 | Exploratory | Improved transmitral flow, end-decompression LV volume, and stroke volume with ACD CPR |
| Barton et al. [10] (1994) | Case report | 1 | Diagnostic | Massive pulmonary embolism as a cause of PEA |
| Ma et al. [11] (1994) | Case report | 1 | Complications | AV disruption complicating CPR |
| Pell et al. [12] (1994) | Prospective observational | 18 | Exploratory | Compression of all four cardiac chambers resulting in forward flow in pulmonary and systemic circulations, retrograde pulmonary vein flow, and incomplete MV closure |
| Antegrade pulmonary vein flow and LV filling observed during relaxation phase | ||||
| Pell et al. [13] (1994) | Prospective observational | 7 | Exploratory | Improved right heart compression, antegrade blood flow patterns, and LV filling during ACD CPR |
| Ma et al. [14] (1995) | Prospective observational | 17 | Exploratory | Presence of opened MV with forward mitral flow and backward pulmonary venous flow during chest compression, suggesting “LA pump” |
| Gilon et al. [15] (1996) | Case report | 1 | Exploratory | RV compression and tricuspid valve closure |
| Huemer et al. [16] (1996) | Case report | 1 | Exploratory | Closure of MV, opening of AV, and reduction of LV cross-sectional area during downstroke of chest compression |
| Van der Wouw et al. [17] (1997) | Prospective observational | 48 | Diagnostic | 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) |
| Hwang et al. [18] (1998) | Prospective observational | 52 | Diagnostic | Pericardial effusion (n = 10), aortic dissection (n = 5), occlusion of the mitral orifice by thrombus (n = 2), main pulmonary artery thrombus (n = 2), thrombotic occlusion of the prosthetic valve (n = 1), hypertrophic cardiomyopathy (n = 1), and aortic stenosis (n = 1) |
| Tsai et al. [19] (1999) | Case report | 1 | Diagnostic | Total tricuspid valve obstruction and massive pulmonary embolism |
| Comess et al. [20] (2000) | Prospective observational | 36 | Diagnostic | Pulmonary emboli in 9 of 25 patients (36%) with pulseless electrical activity as initial event |
| Hwang et al. [21] (2001) | Prospective observational | 14 | Exploratory | Deformation of the aorta at maximal compression site and increase in cross-sectional area of proximal aorta |
| Liu et al. [22] (2002) | Prospective observational | 6 | Exploratory | Closure of mitral and tricuspid valves with simultaneous opening of AV during chest compression |
| Memtsoudis et al. [23] (2006) | Retrospective observational | 22 | Exploratory | Thromboembolic events (n = 9), acute myocardial ischemia (n = 6), hypovolemia (n = 2), and pericardial tamponade (n = 2) |
| Lin et al. [24] (2006) | Prospective observational | 10 | Diagnostic | Myocardial infarction (n = 5), pulmonary embolism (n = 2), and severe hypovolemia and ventricular arrhythmia without specific pathology (n = 2) |
| Blaivas [25] (2008) | Case report | 6 | Diagnostic/monitoring | Identification of VF in patients with asystole on ECG |
| Kim et al. [26] (2008) | Prospective observational | 10 | Exploratory | Retrograde flow to LA and forward blood flow to aorta on LV contrast echocardiography during compression phase |
| Hwang et al. [27] (2009) | Prospective observational | 34 | Exploratory | Significant narrowing of LV outflow tract or aorta during compression phase |
| Weidman et al. [28] (2014) | Case report | 1 | Exploratory | Formation of multiple thrombi in heart and descending thoracic aorta during CA |
| Fair et al. [29] (2016) | Prospective observational | 10 | Guiding catheter cannulation | ECMO guidewire placement and cannula positioning |
| Liu et al. [30] (2016) | Prospective observational | 20 | Exploratory | Cardiac effect at beginning of CA, faded with time, making the thoracic pump dominant mechanism during prolonged CPR |
| Arntfield et al. [31] (2016) | Retrospective observational | 23 | Diagnostic/feasibility of TEE by emergency physicians | High degree of feasibility and clinical utility of ED-based TEE |
| Catena et al. [32] (2019) | Retrospective observational | 19 | Outcome prediction | LV outflow tract opening associated with successful CPR |
| Fair et al. [33] (2019) | Prospective interventional | 25 | Efficacy of TEE on pulse check time | Shorter pulse check times with TEE compared with TTE |
| Kim et al. [34] (2019) | Retrospective observational | 20 | Exploratory | Measurement of compression depth at RV free wall and calculation of compression velocity |
| Lee et al. [35] (2019) | Case report | 1 | Complications | Acute aortic dissection complicating CPR |
| Teran et al. [36] (2019) | Prospective observational | 21 | Diagnostic/CPR quality | Identification of pseudo-PEA and fine VF, determination of reversible pathology, and optimization of CPR quality |
| Giorgetti et al. [37] (2019) | Case report | 1 | Guiding catheterization | Monitoring of mechanical chest compression performance and guiding cannulation for ECPR |
| Long et al. [38] (2020) | Case report | 1 | Monitoring cardiac status | Monitoring of CA due to anaphylaxis |
| Merlin et al. [39] (2020) | Case report | 1 | Trial of out-of-hospital TEE | Report of initial case of out-of-hospital TEE |
| Jung et al. [40] (2020) | Retrospective observational | 158 | Diagnostic/prediction of outcome | Total of 40 patients (25.3%, TEE positive group) with specific TEE findings, including possible causes of CA (n = 31, 19.6%) and sequelae of CA (n = 9, 5.7%) |
| Positive TEE findings were associated with poor resuscitation outcomes | ||||
| Kim et al. [41] (2020) | Case report | 1 | Diagnostic | Paradoxical embolism of right heart thrombi visualized on TEE during CPR |
| Orihashi [42] (2020) | Case report | 4 | Guiding catheterization | Monitoring chest compressions, guiding catheter insertion, and assisting pericardiocentesis |
| Rublee et al. [43] (2020) | Case report | 1 | Diagnostic | Cardiac tamponade and type A aortic dissection |
| Kim et al. [44] (2021) | Retrospective observational | 45 | Diagnostic | Diagnosing aortic dissection as cause of CA |
| Poppe et al. [45] (2021) | Case report | 1 | Diagnostic | Massive intracardiac thrombus and subsequent thrombolysis |
| Horowitz et al. [46] (2021) | Case report | 1 | Diagnostic | Clot in transit in RA and thrombolysis |
| Jung et al. [47] (2022) | Retrospective observational | 97 | Evaluation of intracardiac shunt | Assessment for presence of right-to-left shunt during CPR |
TEE, transesophageal echocardiography; RV, right ventricle; LV, left ventricle; MV, mitral valve; AV, aortic valve; ACD, active compression decompression; CPR, cardiopulmonary resuscitation; PEA, pulseless electrical activities; LA, left atrium; VF, ventricular fibrillation; ECG, electrocardiogram; CA, cardiac arrest; ECMO, extracorporeal membrane oxygenation; ED, emergency department; TTE, transthoracic echocardiography; ECPR, extracorporeal cardiopulmonary resuscitation; RA, right atrium.
Number of patients only includes those who underwent TEE during CA.
Exploratory, determination of mechanism of blood flow during cardiopulmonary resuscitation; Diagnostic, diagnosis of cause of CA.
