Chapter 31: TEE in Cardiac Arrest

The emergent use of TEE during cardiac arrest is explored, including procedural guidance and diagnosis. Video and images will be provided.

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Figures

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Videos

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Tables

eTable 31.4. TEE evaluation post ROSC: TEE extended views, TELUS and TGAUS

	TEE View	View-Technique	Role
1		ME 4C Angle: 0-10° (S4ee figure 4.7)	Pericardial effusion LV/RV size and function RWMA MV and TV abnormalities using CFI IVS communication, shunt Embolization (thrombus, air) Pacing wire position
2		ME AoV SAX Angle: 25-45° (See figure 4.34)	AoV pathologies
3		ME RV Inflow-Outflow Angle: 50-70° (See figure 4.28)	RV free wall motion abnormalities RVOTO (e.g., left tension pneumothorax) TV and PV abnormalities using CFI IVS and IAS communication, shunt Embolization (thrombus, air) Pacing wire position
4		ME 2C Angle: 80-100° (See figure 4.11)	RWMA Embolization (LAA thrombus)
5		ME Bicaval Angle: 90-110° (See figure 4.29)	IAS communication, shunt Embolization (thrombus, air) CVP estimate / preload tolerance /fluid responsiveness using SVC ECPR venous guidewire/cannula position Central venous guidewire position Pacing wire position
6		ME LAX Angle: 120-140° (See figure 4.12)	MV and AoV abnormalities LVOTO/SAM Type 1 aortic dissection Embolization (thrombus, air)
7		TG Mid papillary SAX Transducer angle: 0-20° (See figure 4.16)	Pericardial effusion LV/RV size and function RWMA IVS motion IVS communication, shunt
8		TGAUS LAX IVC Angle: 60-90° (See figure 32.32)	IVC thrombus IVC obstruction (e.g., abdominal compartment syndrome) ECPR venous guidewire/cannula position
9		Descending aorta SAX Angle: 0-10° (See figure 4.25)	Aortic dissection IABP position ECPR arterial guidewire position REBOA position
10		ME Ascending Aorta SAX Angle: 0-30° (See figure 4.15)	Type A dissection PA thrombus
11		TELUS (See Figure 32.10)	Pleural effusion (e.g., hemothorax, empyema) Tension pneumothorax Alveolar-interstitial syndrome Consolidation (e.g., atelectasis, pneumonia)
12		TGAUS (See figure 32.29)	Peritoneal free fluid (e.g., hemoperitoneum) Abdominal aorta dissection Mesenteric ischemia (portal air) Splanchnic venous congestion (VeXUS score)
Abbreviations: 2C, two-chamber; 4C, four-chamber; AoV, aortic valve; CFI, color flow imaging; CVP, central venous pressure; ECPR, extracorporeal cardiopulmonary resuscitation; IABP, intra-aortic balloon pump; IAS, interatrial septum; IVC, inferior vena cava; IVS, interventricular septum; LAA, left atrial appendage; LAX, long-axis; LV, left ventricle; LVOT, left ventricular outflow tract obstruction; LVOTO, left ventricular outflow tract obstruction; ME, mid-esophageal; MV, mitral valve; PA, pulmonary artery; PV, pulmonic valve; REBOA; resuscitative endovascular balloon occlusion of the aorta; ROSC, return of spontaneous circulation; RV, right ventricle; RWMA, right wall motion abnormality; SAM, systolic anterior motion of mitral valve; SAX, short-axis; SVC, superior vena cava; TEE, transesophageal echocardiography; TELUS, transesophageal lung ultrasonography; TG, transgastric; TGAUS, transgastric abdominal ultrasonography; TV, tricuspid valve, VeXUS, venous access ultrasound. Adapted from Riendeau-Beaulac et al^.9