The use of cadavers to simulate transesophageal echocardiography with a mechanical chest compression device: A feasibility study

Abstract

Introduction:

Mechanical chest compression devices and transesophageal echocardiography have become increasingly popular in cardiac arrest management. However, combining these technologies in live patient research is limited due to the rarity of cardiac arrest cases and the specialised nature of both tools. Cadaver models present a potential alternative for study.

Objective:

To evaluate the feasibility of using cadavers to assess transesophageal echocardiography image quality during LUCAS (Lund University Cardiopulmonary Assist System)-assisted compressions and to determine whether these models allow identification of the area of maximal compression.

Methods:

We conducted a prospective feasibility study using two unembalmed, previously frozen, and exsanguinated cadavers. Standard transesophageal echocardiography views, including the Mid-Esophageal Long-Axis and Mid-Esophageal Four Chamber, were attempted. The primary outcome was assessing image quality with the ACEP (American College of Emergency Physicians) Emergency Ultrasound Reporting Guidelines; the secondary outcome was the ability to identify and measure the area of maximal compression. Inter-rater reliability was calculated using Cohen’s Kappa.

Results:

A total of 12 transesophageal echocardiography videos were recorded. Mean image quality was rated as 1.8 and 2.1 out of 5, suggesting that structures were minimally recognisable but inadequate for diagnosis. Cohen’s Kappa was 0.32, indicating fair inter-rater agreement. Due to poor image quality, the area of maximal compression could not be reliably identified or measured.

Conclusion:

Unembalmed cadavers are suboptimal models for evaluating transesophageal echocardiography during mechanical chest compressions. These findings, though negative, provide insight into the limitations of cadaveric simulations for transesophageal echocardiography–guided cardiopulmonary resuscitation research. Alternative models, such as high-fidelity manikins or better optimised cadavers, may be better suited for future investigations.