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Ultrasound in Cardiac Arrest Resuscitation by Haney Mallemat

Haney Mallemat states the case for ultrasound in cardiac arrest resuscitation.

He tells the story of Stephen, a 43-year-old male who suffers a cardiac arrest. Unfortunately, whilst looking for reversible causes with a transthoracic echocardiogram (TTE), chest compressions stopped, and Stephen died.

Enter the trans-(o)esophageal echocardiogram (TEE).

A trans-esophageal echocardiogram is an amazing diagnostic tool. It works in exactly the same way as any other ultrasound – there is a transducer on the end of a handle.

The difference is that the stem is flexible and inserted down a patient’s oesophagus. This provides fantastic clear images in any patient, with no soft tissue or bones in the way. As a result if you already know how to look at transthoracic echocardiogram, then there is no learning curve.

TEE can rapidly identify reversible causes of cardiac arrest, for instance a pulmonary embolism, a clot in transit, aortic dissections or papillary muscle ruptures. Moreover, it can do this without causing any interruptions to the resuscitation effort, including the chest compression.

TEEs can also demonstrate the effectiveness of CPR in real time – goal directed chest compressions. In a similar vein, TEE can measure the depth of compressions providing valuable information for the team involved in resuscitation.

Back to Stephen. Instead of interrupting chest compressions, a TEE was used instead. A TEE echocardiogram elicited fine ventricular fibrillation that was not picked up on telemetry. This led to a lifesaving intervention, and Stephen walked out of the hospital a few weeks later.

Haney will convince you that TEE is a game changer in cardiac arrest resuscitation. TEE provides high quality images of the heart without interruption in CPR. Additionally TEE provides useful information about compression depth and quality that no other diagnostic tool provides.

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Haney Mallemat

Dr. Haney Mallemat is board certified in Emergency Medicine, Internal Medicine, and Critical Care Medicine and works in the Emergency Department and Intensive Care Unit in Baltimore Maryland. He has lectured both nationally and internationally, and has contributed to several Emergency Medicine and Critical Care podcasts. He is a firm believer in the benefits of bedside ultrasound for better patient care. He also uses ultrasound to help education medical students, residents, fellows, nurses, and mid-level providers. He was awarded the Department of Emergency Medicine “Outstanding Teaching Award” in 2012, in 2013, and in 2015.