van der Wouw P A, Koster R W, Delemarre B J, de Vos R, Lampe-Schoenmaeckers A J, Lie K I
Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
J Am Coll Cardiol. 1997 Sep;30(3):780-3. doi: 10.1016/s0735-1097(97)00218-0.
We sought to establish the diagnostic accuracy of transesophageal echocardiography (TEE) during cardiopulmonary resuscitation.
Because of its bedside diagnostic capabilities, excellent cardiac images and lack of interference with resuscitation efforts, TEE is ideally suited to determine the cause of a circulatory arrest that is not due to severe arrhythmia. However, the diagnostic accuracy of TEE during resuscitation is unknown.
TEE was performed in patients with prolonged circulatory arrest. The TEE diagnoses were compared with diagnoses from autopsy, surgery and clinical follow-up.
Of the 48 study patients (29 male, 19 female, mean age +/- SD 61 +/- 20 years), 28 had an in-hospital cardiac arrest and 20 an out-of-hospital onset of arrest. Forty-four patients eventually died; four survived to discharge. The diagnoses made with TEE were 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). A definite diagnosis from a reference standard was available in 31 patients. The TEE diagnosis was confirmed in 27 of the 31-by postmortem examination (n = 19), operation (n = 2), angiography (n = 2) or clinical course (n = 4). In the other four patients the TEE diagnosis proved incorrect by postmortem examination. The sensitivity, specificity and positive predictive value of TEE were 93%, 50% and 87%, respectively. In 15 patients (31%), major therapeutic decisions were based on TEE findings.
TEE can reliably establish the cause of a circulatory arrest during cardiopulmonary resuscitation.
我们试图确定经食管超声心动图（TEE）在心肺复苏期间的诊断准确性。
由于其床旁诊断能力、出色的心脏图像以及对复苏操作无干扰，TEE非常适合用于确定非严重心律失常所致循环骤停的病因。然而，TEE在复苏期间的诊断准确性尚不清楚。
对循环骤停时间延长的患者进行TEE检查。将TEE诊断结果与尸检、手术及临床随访诊断结果进行比较。
48例研究患者（男性29例，女性19例，平均年龄±标准差61±20岁）中，28例为院内心脏骤停，20例为院外心脏骤停。44例患者最终死亡；4例存活出院。TEE诊断结果为心包填塞（n = 6）、心肌梗死（n = 21）、肺栓塞（n = 6）、主动脉破裂（n = 1）、主动脉夹层（n = 4）、乳头肌破裂（n = 1）、其他诊断（n = 2）以及无心脏结构异常（n = 7）。31例患者可获得参考标准的明确诊断。31例患者中有27例的TEE诊断经尸检（n = 19）、手术（n = 2）、血管造影（n = 2）或临床病程（n = 4）得到证实。另外4例患者的TEE诊断经尸检证明不正确。TEE的敏感性、特异性和阳性预测值分别为93%、50%和87%。15例患者（31%）的主要治疗决策基于TEE检查结果。
TEE能够可靠地确定心肺复苏期间循环骤停的病因。
