• Makoto Miyake, Chisato Izumi, Shuichi Takahashi, Yoshihiro Himura, Hiromitsu Gen, and Takashi Konishi.
• Department of Cardiology, Tenri Hospital, Mishima-cho 200, Tenri, Nara 632-8852.
• J Cardiol. 2004 Nov 1;44(5):189-94.

ObjectivesOnly a few examinations are available to critically ill patients. We assessed the efficacy of transesophageal echocardiography (TEE) in the management of patients with cardiac arrest or shock.MethodsAmong a total of 2,021 patients who underwent TEE over the past 13 years at our institution, we reviewed 18 patients who underwent TEE during cardiac arrest or shock.ResultsTEE was performed in four patients with cardiac arrest and in 14 patients with shock. In 12 (67%) of 18 patients, TEE identified the following abnormalities: aortic dissection in four, ruptured thoracic aortic aneurysm in two, papillary muscle rupture in two, left ventricular free wall rupture in two, postoperative cardiac tamponade in one and ruptured chordae tendineae in one. TEE excluded suspected cardiac abnormality in two other patients. Transthoracic echocardiography could not be performed in 8 of 18 patients, and showed poor quality of images in the remaining 10 patients. Of the 12 patients with a diagnosis based on TEE, three patients died during cardiopulmonary resuscitation, whereas nine patients were treated with emergent surgery and six of these survived to hospital discharge.ConclusionsTEE is feasible even in patients with cardiac arrest or shock, and can play an important role in establishing the diagnosis and determining the treatment of such patients.

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