TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING CLOSED-CHEST CARDIAC MASSAGE - THE CARDIAC PUMP THEORY CONFIRMED

Cardiorespiratory arrest occurred in a 64-year-old man with severe triple-vessel coronary artery disease (status after two myocardial infarctions) and heart failure (ejection fraction of 20%). After intubation and starting resuscitation measures, transoesophageal echocardiography (TE) was performed to exclude electromechanical dissociation with ventricular tamponade. During the thoracic compression of closed-chest cardiac massage the aortic valve opened, while the mitral and tricuspid valves closed. During the relaxation phase the mitral and tricuspid valves rapidly opened, the aortic valve closed. When the cardiac massage was stopped (wide, fixed pupils) echo density increased spontaneously in all four cardiac chambers due to the cessation of blood flow. On resuming thoracic compression after about 30 sec the echo density decreased, first in the right ventricle, then right atrium, followed by left atrium and finally left ventricle. This is the first time that the wash-out of spontaneous echo-contrast has been reported in these circumstances. It makes it possible, together with the movements of the cardiac valves during thoracic compression, to state precisely the localization and direction of blood flow during closed-chest cardiac massage in man. The observations confirm the correctness of the cardiac pump theory rather than the thoracic pump one.