Intracardiac thrombus can develop rapidly during cardiac arrest as a consequence of the low-flow state. In one study, new thrombus formation was observed approximately 6 minutes after the onset of cardiac arrest. Therefore, identifying a right-sided thrombus during resuscitation does not always mean that pulmonary embolism (PE) caused the arrest—particularly when the finding appears later in the resuscitation or after prolonged downtime. Nevertheless, a clot-in-transit with a

When transitioning from transthoracic echocardiography (TTE) to transesophageal echocardiography (TEE), one of the simplest ways to orient yourself is to remember that corresponding TEE views often appear flipped compared with their familiar TTE counterparts. The same cardiac structures are present but their orientation on the screen is reversed, because the ultrasound beam approaches the heart from the esophagus rather than the chest wall. Recognizing this relationship can m

In patients with spontaneous circulation, systolic right atrial and diastolic right ventricular collapse are important echocardiographic signs of cardiac tamponade. During cardiac arrest, however, the absence of normal forward flow and intracardiac pressures makes these findings much less reliable. As a result, the presence or absence of right-sided chamber collapse should not be used in isolation to determine whether a pericardial effusion is responsible for the patient's ca

Transesophageal echocardiography (TEE) provides several important advantages over transthoracic echocardiography (TTE) during cardiac arrest. Because the probe lies immediately behind the heart, TEE consistently produces higher-quality images while avoiding many of the limitations of TTE including obesity, positive-pressure ventilation, and poor acoustic windows. TEE also obviates obstacles to transthoracic imaging such as defibrillator pads, active chest compressions, and me

Yet another study adds to growing evidence that guideline-recommended hand placement for chest compressions may not correspond to the optimal anatomic target. In this prospective ultrasound study of 152 adults, investigators used transthoracic echocardiography to identify the left ventricular outflow tract (LVOT) and the ideal area of maximal compression (iAMC), then mapped these structures onto standardized external chest-wall coordinates relative to the sternum. The LVOT wa

Cardiac tamponade is one of the few potentially reversible causes of cardiac arrest. When a pericardial effusion is identified during cardiac arrest and the clinical presentation raises suspicion for tamponade physiology, emergent pericardial drainage should be performed. In one study, patients undergoing pericardiocentesis for suspected tamponade during cardiac arrest had a substantially higher survival to hospital discharge than all other patients (15% vs. 1%), highlighting