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DOI: 10.1055/a-1530-4919
Rolle der Echokardiografie bei Notfällen und hämodynamischer Instabilität
Echocardiography as a Diagnostic Tool in Emergencies and Hemodynamic Instability
Die transthorakale (TTE) und die transösophageale (TEE) Echokardiografie sind bei Notfällen etabliert – Verdachtsdiagnosen können bestätigt und die meisten Ursachen einer hämodynamischen Instabilität erkannt werden. Dieser Beitrag stellt die „fokussierten“ Untersuchungsabläufe der TTE und TEE vor: Sie erfassen die wesentlichen Befunde bei hämodynamisch instabilen Patienten im Notfall und beeinflussen so maßgeblich die Therapieentscheidungen.
Abstract
Echocardiography is an imaging method in anaesthesia and intensive care medicine which adds a new dimension to hemodynamic monitoring: the direct visualization of the cardiac function and its disruptions. The review article shows the advantages and limitations of recent transthoracic (TTE) and transesophageal (TEE) echocardiography in the diagnostic course of hemodynamic instability. For TTE and TEE focused examination techniques and sequences are illustrated with regards to their fast applicability to hemodynamic monitoring.
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Die meisten Entscheidungen in hämodynamischen Notfallsituationen hängen von Befunden der transthorakalen und der transösophagealen Echokardiografie ab.
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Die Echokardiografie ist die einzige Methode, die eine Darstellung kardialer Strukturen und ihrer Funktion in Echtzeit erlaubt.
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Eine fokussierte Echokardiografie ist eine zielgerichtete, schnelle, im Blickfeld begrenzte, vom Behandler durchführbare und wiederholbare, qualitative und semiquantitative Point-of-Care-Untersuchungsmethode.
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Ein modifizierter Untersuchungsablauf mit 8 Standardschnitten der transösophagealen Echokardiografie erlaubt mit wenigen Sondenbewegungen schnell eine Erfassung der wesentlichen Befunde bei hämodynamisch instabilen Notfallpatienten.
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Die fokussierte transthorakale Echokardiografie kann mit 5 standardisierten Schnitten (ohne Sonografie der Pleuren) die wesentlichen Ursachen der hämodynamischen Instabilität untersuchen.
Schlüsselwörter
Notfallechokardiografie - fokussierte Echokardiografie - transthorakale Echokardiografie - transösophageale Echokardiografie - hämodynamische InstabilitätKeywords
emergency echocardiography - focussed cardiac ultrasound - transthoracic echocardiography - hemodynamic instability - transesophageal echocardiographyPublication History
Article published online:
18 May 2022
© 2022. Thieme. All rights reserved.
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Literatur
- 1 Frankel HL, Kirkpatrick AW, Elbarbary M. et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part I: General Ultrasonography. Crit Care Med 2015; 43: 2479-2502 DOI: 10.1097/CCM.0000000000001847. (PMID: 27182849)
- 2 Levitov A, Frankel HL, Blaivas M. et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med 2016; 44: 1206-1227 DOI: 10.1097/CCM.0000000000001847. (PMID: 27182849)
- 3 Neskovic AN, Hagendorff A, Lancellotti P. et al. Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. Eur Heart J Cardiovasc Imaging 2013; 14: 1-11 DOI: 10.1093/ehjci/jes193. (PMID: 23239795)
- 4 Varriale P, Maldonado JM. Echocardiographic observations during in hospital cardiopulmonary resuscitation. Crit Care Med 1997; 25: 1717-1720 DOI: 10.1097/00003246-199710000-00023. (PMID: 9377888)
- 5 Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. BMJ 2006; 333: 334-339 DOI: 10.1136/bmj.333.7563.334. (PMID: 16902214)
- 6 Chirillo F, Totis O, Cavarzerani A. et al. Usefulness of transthoracic and transoesophageal echocardiography in recognition and management of cardiovascular injuries after blunt chest trauma. Heart 1996; 75: 301-306 DOI: 10.1136/hrt.75.3.301. (PMID: 8800997)
- 7 Vincent JL, Pelosi P, Pearse R. et al. Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12. Crit Care 2015; 19: 224 DOI: 10.1186/s13054-015-0932-7. (PMID: 25953531)
- 8 Via G, Hussain A, Wells M. et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr 2014; 27: 683.e1-683.e33
- 9 Godement M, Malbrain M, Vieillard-Baron A. Emergency bedside ultrasound-benefits as well as caution: Part 2: Echocardiography. Curr Opin Crit Care 2019; 25: 605-612 DOI: 10.1097/MCC.0000000000000674. (PMID: 31567518)
- 10 Mathew JP, Glas K, Troianos CA. et al. American Society of Echocardiography/Society of Cardiovascular Anesthesiologists recommendations and guidelines for continuous quality improvement in perioperative echocardiography. J Am Soc Echocardiogr 2006; 19: 1303-1313 DOI: 10.1016/j.echo.2006.08.039. (PMID: 17098131)
- 11 Cheitlin MD, Armstrong WF, Aurigemma GP. et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation 2003; 108: 1146-1162 DOI: 10.1016/S0894-7317(03)00685-0. (PMID: 14566308)
- 12 Porter TR, Shillcutt SK, Adams MS. et al. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr 2015; 28: 40-56 DOI: 10.1016/j.echo.2014.09.009. (PMID: 25559474)
- 13 Jensen MB, Sloth E, Larsen KM. et al. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol 2004; 21: 700-707 DOI: 10.1017/s0265021504009068. (PMID: 15595582)
- 14 Labovitz AJ, Noble VE, Bierig M. et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 2010; 23: 1225-1230 DOI: 10.1016/j.echo.2010.10.005. (PMID: 21111923)
- 15 Reeves ST, Finley AC, Skubas NJ. et al. Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013; 26: 443-456 DOI: 10.1213/ANE.0b013e3182a00616. (PMID: 23966648)
- 16 Navas-Blanco JR, Louro J, Reynolds J. et al. Intraoperative focused cardiac ultrasound for assessment of hypotension: a systematic review. Anesth Analg 2021; 133: 852-859 DOI: 10.1213/ANE.0000000000005336. (PMID: 33346986)
- 17 Balderston JR, You AX, Evans DP. et al. Feasibility of focused cardiac ultrasound during cardiac arrest in the emergency department. Cardiovasc Ultrasound 2021; 19: 19 DOI: 10.1186/s12947-021-00252-3. (PMID: 34039347)
- 18 Catena E, Colombo R, Volonte A. et al. Transesophageal echocardiography in patients with cardiac arrest: from high-quality chest compression to effective resuscitation. J Echocardiogr 2021; 19: 28-36
- 19 Taylor B, Joshi B, Hutchison L. et al. Echocardiography does not prolong peri-shock pause in cardiopulmonary resuscitation using the COACH-RED protocol with non-expert sonographers in simulated cardiac arrest. Resusc Plus 2020; 4: 100047 DOI: 10.1016/j.resplu.2020.100047. (PMID: 34223322)
- 20 Soar J, Berg KM, Andersen LW. et al. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2020; 156: A80-A119 DOI: 10.1016/j.resuscitation.2020.09.012. (PMID: 33099419)
- 21 Szekely Y, Lichter Y, Taieb P. et al. Spectrum of cardiac manifestations in COVID-19: A systematic echocardiographic study. Circulation 2020; 142: 342-353 DOI: 10.1161/CIRCULATIONAHA.120.047971. (PMID: 32469253)
- 22 Johri AM, Galen B, Kirkpatrick JN. et al. ASE Statement on Point-of-Care Ultrasound during the 2019 Novel Coronavirus Pandemic. J Am Soc Echocardiogr 2020; 33: 670-673 DOI: 10.1016/j.echo.2020.04.017. (PMID: 32503704)
- 23 Silverio A, Di Maio M, Scudiero F. et al. Clinical conditions and echocardiographic parameters associated with mortality in COVID-19. Eur J Clin Invest 2021; 51: e13638 DOI: 10.1111/eci.13638. (PMID: 34287861)