Question 17.2
With reference to transthoracic echocardiography (TTE) in the critically ill:
The four images shown on pages 4 and 5 are TTE images taken from two patients during resuscitation from cardiac arrest.
Figures 1a and 1b are from patient 1 (shown on page 4). Figures 2a and 2b are from patient 2 (shown on page 5).
For each TTE image:
i. Describe the main abnormalities.
ii. Give the underlying diagnosis.
College Answer
For Patient 1
1) Very large pericardial effusion
2) Right ventricular compression.
Cardiac tamponade
For Patient 2
1) Grossly dilated right ventricle (and atrium in fig 4)
2) D-shaped septum
3) Underfilled left heart
Massive pulmonary embolus
Discussion
The TTE stills depicted above are not the canonical CICM paper images; instead I have scraped them together from various Google searches, from authors who have tagged them as "labelled for reuse".
The images are easily recognisable and I will not expand on this beyond wat is said in the college answer and explained in the chapter on peri-arrest TTE.
References
Price, Susanna, Shahana Uddin, and Tom Quinn. "Echocardiography in cardiac arrest." Current opinion in critical care 16.3 (2010): 211-215.
Zafiropoulos, Andreas, et al. "Critical Care Echo Rounds: Echo in cardiac arrest." Echo Research and Practice 1.2 (2014): D15-D21.
Flato, Uri Adrian Prync, et al. "Echocardiography for prognostication during the resuscitation of intensive care unit patients with non-shockable rhythm cardiac arrest." Resuscitation 92 (2015): 1-6.
Anderson, Kenton L., et al. "Ultrasound Guided Chest Compressions Over the Left Ventricle During Cardiopulmonary Resuscitation Increases Coronary Perfusion Pressure and Return of Spontaneous Circulation in a Swine Model of Traumatic Cardiac Arrest." Circulation 130.Suppl 2 (2014): A15853-A15853.
Memtsoudis, Stavros G., et al. "The usefulness of transesophageal echocardiography during intraoperative cardiac arrest in noncardiac surgery." Anesthesia & Analgesia 102.6 (2006): 1653-1657.
Blyth, Lacey, et al. "Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review." Academic Emergency Medicine 19.10 (2012): 1119-1126.
Labovitz, Arthur J., et al. "Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians." Journal of the American Society of Echocardiography 23.12 (2010):