To examine the usefullness of Transesopahegeal Echocardiography (TEE) during non-cardiac surgery intraoperative cardiac arrest.
Patients who suffered an intraoperative cardiac arrest during non-cardiac surgery (1995-2002) were included in the analysis. Surgical operative notes and anesthesia records were reviewed and pertinent data collected. Echocardiogarphy records and review of videotape recordings were used and evaluated for findings. The impact of echocardiographic results on treatment was assessed. Finally, survival data were recorded.
Twenty-two patients (15 male / 7 female) were identified, who suffered an intraoperative cardiac arrest during non-cardiac surgical procedures. Median age was 60.5 years (range 29 –84 years). In all patients the ACLS protocol was implemented. In 86,4% (19 of 22) of patients a primary diagnosis could be established with TEE. In 81,8% (18 of 22) of patients the TEE findings aided in their further management, and in 54,5% (12 of 22) of patients specific surgical interventions were implemented based on these findings. Diagnosis with TEE revealed signs of myocardial ischemia in 27,3% (6 of 22) of all patients and 3 of these patients underwent emergency coronary artery bypass grafting. In 40,9% (9 of 22) off all patients thromboembolic events of the central vasculature were diagnosed. In 6 patients clots were visualized directly and in 3 indirect signs of pulmonary embolism were identified. Five patients underwent emergency pulmonary embolectomy hrombectomy. Nine percent (2 of 22) of all patients with pericardial tamponade were treated by pericardiotomy. In 9,1% (2 of 22) of all patients the diagnosis of hypovolemia was made and these patients responded well to fluid resuscitation. Fourteen patients (63%) survived to leave the operating room. Seven (31,8%) of these patients were discharged, while 8 (36,4%) succumbed shortly after the intra operative arrest.
TEE was the primary source for diagnosis in 86,4% of all patients. In the majority of patients these findings influenced management.
Despite limitations of this analysis, we recommend the employment of TEE in a cardiac arrest situation in the operating room whenever possible.
Stavros Memtsoudis, None.