Abstract Sun708: The Impact of Intra-Arrest TEE on Epinephrine Administration in In-Hospital Cardiac Arrest: A Resuscitative TEE Collaborative Registry (rTEECoRe) Study

Abstract

Background: Intra-arrest transesophageal echocardiography (TEE) is increasingly used during in-hospital cardiac arrest (IHCA) to guide resuscitation with evidence that directing the area of maximal compression (AMC) may improve outcomes. While TEE offers potential benefits for real-time decision-making, limited data exist regarding the impact of intra-arrest TEE on standard CA resuscitative efforts. We analyzed the Resuscitative TEE Collaborative Registry (rTEECoRe), a multicenter registry of acute care TEE, to evaluate the safety profile of intra-arrest TEE. We examined the temporal relationship of TEE-guided AMC evaluation attempt with the delivery of standard epinephrine administration. Methods: We analyzed IHCA patients evaluated with TEE collected through the Resuscitative TEE Collaborative Registry (NCT04972526). Patients in whom TEE was used to evaluate the AMC and those without AMC evaluation were included for analysis. We investigated the association between the attempt to identify the AMC and the timing of standard resuscitation interventions, specifically the time to first epinephrine administration. Linear regression was used to assess the relationship between AMC evaluation attempt and time to first epinephrine. Statistical significance was set at p < 0.05. Results: Among 117 patients who received intra-arrest TEE during in-hospital cardiac arrest, attempts to evaluate the AMC were not associated with significant delays in the administration of the first epinephrine dose (p = 0.114). In logistic regression analysis, AMC evaluation attempt was also not associated with return of spontaneous circulation (ROSC) (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.59–4.11; p = 0.39) or survival to hospital discharge (OR 0.54, 95% CI 0.15–2.06; p = 0.34). Other covariates, including age, sex, CPR modality, initial rhythm, and arrest location, were not significantly associated with either outcome. Conclusion: In this multicenter cohort of patients undergoing intra-arrest TEE during IHCA, evaluation of AMC was not associated with delays in epinephrine administration or with differences in ROSC or survival to discharge. These findings support the idea that focused intra-arrest TEE imaging, including the assessment of AMC, can be performed without compromising the timely delivery of standard resuscitation interventions.