TRANSESOPHAGEAL  ECHOCARDIOGRAPHIC ASSESSMENT  OF CARDIAC MOVEMENT, VENTRICULAR FUNCTION AND VALVE MOTION DURING CARDIOPULMONARY RESUSCITATION

Hwang, Sung Oh; Kim, Young Sik; Lim, Kyoung Soo; Lee, Boo Soo; Lee, Kang Hyun; Ahn, Moo Eob; Yoon, Jung Han; Park, Keum Soo; Choe, Kyung Hoon

J Korean Soc Emerg Med > Volume 5(2); 1994 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1994;5(2): 135-146.

TRANSESOPHAGEAL ECHOCARDIOGRAPHIC ASSESSMENT OF CARDIAC MOVEMENT, VENTRICULAR FUNCTION AND VALVE MOTION DURING CARDIOPULMONARY RESUSCITATION

Sung Oh Hwang¹, Young Sik Kim¹, Kyoung Soo Lim¹, Boo Soo Lee¹, Kang Hyun Lee¹, Moo Eob Ahn¹, Jung Han Yoon², Keum Soo Park², Kyung Hoon Choe²

¹Department of Emergency Medicine, Wonju College of Medicine, Wonju, Korea
²Department of Internal Medicine, Wonju College of Medicine, Wonju, Korea

Published online: December 31, 1994.

ABSTRACT

Background
Mechanism of blood flow during cardiopulmonary resuscitation(CPR) in hu mans remains controversial and poorly understood, although cardiac or thoracic pump theory was proposed. We investigated cardiac movement, ventricular function and atrioventricular valve motion with aid of transesophageal echocardiography during precordial compression dur ing CPR in humans.
Methods and results
During CPR transesophageal echocardiography was performed in 14 patients with non-traumatic cardiac arrest. Manual precordial compression during CPR was performed according to American Heart Association guidelines. Mitral valve closed in 9 and did not close in 5 patients during "compression systole". Tricuspid valve closed during compres sion systole. Compression vector directed to right ventricle, basal portion of interventricular sep tum and left atrium. The heart rotated clockwise and the apex was more displaced than the base("swing motion"). Fractional shortening(FS) and ejection fraction(EF) of right ventricle exceeded those of left ventricle(FS : 55土 9% vs 18土8%, p<0.05), EF : 79土9% vs 37土16%, p<0.05). FS and EF of left ventricle was higher in patients with systolic mitral valve closure than patients with persistent systolic opening of mitral valve( FS : 21 土 7 vs 13 土 7%, EF : 45 ± 12 vs 22 土12 %, p< 0.05), but FS and EF of right ventricle was not different.
Conclusion
During precordial compression, the heart rotated clockwise and displaced. Systolic function of right ventricle exceeded left ventricle. Marked compression of right ventricle and systolic closure of tricuspid valve suggested that right ventricle functioned as a pump generating blood flow during precordial compression. Closure of mitral valve was dependant on systolic function of the left ventricle.

Key words: Cardiopulmonary Resuscitation, Transesophageal Echocardiography