Abstract 182: Transesophageal Echocardiography for Assessment of Fluid Responsiveness After Resuscitation From Cardiac Arrest
Background: Fluid therapy for hemodynamic stabilization after cardiac arrest is challenging as hypovolemia and fluid overload may cause circulatory failure. Therefore, predicting fluid responsiveness is an important issue. Transesophageal echocardiography (TEE) may provide helpful information whether stroke volume will increase after fluid loading. Aim of the present study was to evaluate the performance of TEE to predict fluid responsiveness in the post-cardiac arrest period.
Methods: After IRB approval, electrically induced cardiac arrest of 8 minutes was followed by CPR in 20 anesthetized pigs. TEE was performed and recorded before a 5 ml/kg fluid bolus at baseline, and both 1 and 4 hours after return of spontaneous circulation (ROSC) using mid-esophageal long-axis view. TEE loops were independently presented in randomized order to 7 blinded TEE-experts who were asked to predict whether the ventricle displayed on the loop will increase stroke volume > 15% after fluid administration (responders). Further, TEE derived respiratory variation of velocity time integral (dVTI), a dynamic variable of fluid responsiveness, was analyzed. Statistics were performed by binary classification and receiver-operator characteristics (ROC).
Results: 16 animals were successfully resuscitated and a total of 86 loops and 602 expert ratings were included into final analysis. Eyeballing showed acceptable sensitivity before and after ROSC. Specificity, however, was limited and best 1 hour after ROSC. dVTI showed good prediction of fluid responsiveness at baseline and four hours after ROSC (p<0.01 for area under the ROC-curve) but was failed one hour after ROSC. Table 1 presents sensitivity and specificity of both methods to predict fluid responsiveness.
Conclusions: TEE is helpful for prediction of fluid responsiveness following resuscitation from cardiac arrest. Evaluation of long-axis TEE loops by eyeballing is superior to the dynamic variable dVTI at 1 hour after ROSC.
- © 2010 by American Heart Association, Inc.