Mid-esophageal Long Axis window: The Left Ventricular Outflow Tract (LVOT) and aortic root are being compressed during mechanical cardiopulmonary resuscitation. Compression location needs to change to over the Left Ventricle such that the LVOT is open with each compression to allow for perfusion.
A patient in cardiac arrest is intubated and brought to the emergency department. Team 1 is running the resuscitation and team 2 is obtaining focused transesophageal echocardiography (TEE) views. The resuscitation is ultimately unsuccessful. Upon review of the focused TEE mid esophageal long axis images, the above clip was illuminating.
Focused TEE mid esophageal long axis view shows that chest compressions are maximally compressing the Left Ventricular Outflow Tract (LVOT) and aortic root. Chest compressions should be maximally compressing the left ventricle and the LVOT should open with each compression.
There is limited evidence (which makes intuitive sense) that resuscitation will fail if the LVOT is closed with each compression as shown here. As the left ventricle is compressed, the LVOT should be open to allow for perfusion. Compression location in the case above needs to change. [DOI.org/10.1016/j.resuscitation.2019.02.027]