Success of focused transthoracic echocardiography locations for cardiac visualization during cardiac arrest: A video-review analysis

Abstract

Objective: Our primary objective was to determine if there was a difference in success of cardiac visualization by focused transthoracic echocardiography (TTE) location (subxiphoid, parasternal, or apical) during chest compression interruptions among cardiac arrest patients. Secondarily, we sought to determine whether there were differences in chest compression interruption times with the focused TTE locations. Methods: We conducted a retrospective cohort study of video-recorded, adult, cardiac arrest resuscitations in a quaternary care Emergency Department from 11/2018 to 11/2023. Focused TTE was successful if 1) cardiac visualization was seen on video review, or 2) cardiac visualization was discussed in the recording. A chi-squared test was used to assess differences in success and ANOVA was used to assess differences in interruption times based on TTE locations. Repeated measures multivariable regression models were constructed to control for clinically relevant variables for the primary and secondary objectives. Results: 136 patients and 365 focused TTE attempts were included in the study (241 subxiphoid, 101 parasternal, and 23 apical). There was no difference in the success rate: subxiphoid 83.4%, parasternal 88.1%, and apical 95.7% (p = 0.190) or in multivariable regression analysis (p = 0.189). There was no difference in the mean chest compression interruption time for each site: subxiphoid 15 sec. (IQR 12–23 sec.), parasternal 17 sec. (IQR 11–22 sec.), and apical 19 sec. (IQR 15–25 sec., p = 0.446) or in multivariable logistic regression analysis (p = 0.803). Sonographers with ≥ 50 quality assured focused TTEs had higher success than those without (94.4% vs. 75.1%; p < 0.001). Conclusions: In cardiac arrest, the parasternal and apical TTE locations had similar success of cardiac visualization and similar compression interruption times to the more commonly used subxiphoid location.