Hemodynamic effects of TEE-guided adjustment of the area of the maximal compressions during cardiopulmonary resuscitation.
Journal
Resuscitation
Start Page
Article number 111097
ISSN
1873-1570
Date Issued
2026-04-14
Author(s)
Chen, Chia-Ching
Chen, Tai-Yuan
Wu, Cheng-Yi
Wu, Meng-Che
Hsu, Shu-Hsien
Lien, Wan-Ching
Tay, Joyce
Abstract
Background: Real-time evidence on left ventricular (LV) parameters during cardiopulmonary resuscitation (CPR), especially before and after adjusting the area of maximal compression (AMC), is limited. This study used three-dimensional transesophageal echocardiography (3D-TEE) to assess LV parameters during resuscitation with and without AMC adjustment. Methods: Adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA) were prospectively enrolled. The AMC was identified by two-dimensional (2D)-TEE and LV end-diastolic volume (EDV), and end-systolic volume (ESV) were measured by 3D-TEE to derive stroke volume (SV) and ejection fraction (EF). If AMC aligned with the LV (AMC-LV group), chest compressions were continued; otherwise, the site was adjusted (AMC-non-LV group) for optimal LV alignment and measurements repeated. End-tidal carbon dioxide (EtCO2) data were collected at the time of AMC identification and 1 min after AMC adjustment. Results: Nineteen patients were included. The AMC was located over the LV in 4 patients (21%), while 15 patients (79%) required TEE-guided AMC adjustment. In the AMC-non-LV group, SV (9 vs. 28.6 mL, p = 0.004), EF (20.4 vs. 60.8%, p < 0.0001) and EtCO2 (19 vs. 42 mmHg, p < 0.0001) increased significantly post-adjustment, reaching values comparable to the AMC-LV group. ROSC rates did not differ between the AMC-LV and AMC-non-LV groups (75% vs. 53%, p = 0.603). Conclusions: 2D-TEE-guided identification and adjustment of AMC allowed targeted optimization of chest compressions. Approximately 80% of patients required AMC adjustment. 3D-TEE was used to quantify LV parameters. In patients undergoing AMC adjustment, significant improvements in SV and EF were observed, reaching levels comparable to those without adjustment.
Subjects
Area of maximal compressions (AMC)
Cardiopulmonary resuscitation (CPR)
Out-of-hospital cardiac arrest (OHCA)
Return of spontaneous circulation (ROSC)
Three-dimensional transesophageal echocardiography (3D-TEE)
Transesophageal echocardiography (TEE)
Two-dimensional (2D) transesophageal echocardiography (2D-TEE)
Type
journal article