BACKGROUND: During the secondary survey of advanced cardiac life support (ACLS), differential diagnosis to seek the cause of cardiac arrest is an important step in patient who failed to restore spontaneous circulation after the primary survey and resuscitation. This study was to evaluate the role of transesophageal echocardiography (TEE) for assessing the cause of cardiac arrest during the secondary survey of ACLS. METHOD: We performed biplane TEE during cardiopulmonary resuscitation (CPR) in 52 consecutive patients (31 male, 21 female, mean age: 58 years old) with cardiac arrest who failed to restore spontaneous circulation after the primary survey and resuscitation attempt. Initial presenting ECG rhythm was ventricular fibrillation in 7, asystole in 25, and pulseless electrical activity in 20 patients. TEE was performed immediately if spontaneous circulation was not restored after the primary survey and resuscitation. Possible causes of cardiac arrest were detected in 23 patients (44%) by TEE. Positive findings were observed in 3 (43%) of 7 patients with ventricular fibrillation, 12 (48%) of 25 patients with asystole, and 8 (40%) of 20 patients with pulseless electrical activity. TEE findings were as followings : pericardial effusion in 10, aortic dissection in 5, occlusion of mitral orifice by a thrombus or a mass in 2, main pulmonary artery thrombus in 2, thrombotic occlusion of the prosthetic valve in 1, hypertrophic cardiomyopathy in 1, and aortic stenosis in 1. Interventions including pericardiocentesis (n=10) and emergency thoracotomy (n=1) were attempted during resuscitation. Spontaneous circulation was restored in 16 patients (31%). One patient was discharged alive. CONCLUSION: TEE is an useful diagnostic tool to identify the cause of cardiac arrest during the secondary survey of ACLS.
Advanced Cardiac Life Support* ; Aortic Valve Stenosis ; Cardiomyopathy, Hypertrophic ; Cardiopulmonary Resuscitation ; Diagnosis, Differential* ; Echocardiography, Transesophageal* ; Electrocardiography ; Emergencies ; Female ; Heart Arrest* ; Humans ; Male ; Pericardial Effusion ; Pericardiocentesis ; Pulmonary Artery ; Resuscitation ; Thoracotomy ; Thrombosis ; Ventricular Fibrillation

BACKGROUND: A p53 gene is one of the member of tumor suppressor genes involved in the control of cell cycle. The alteration of the p53 gene induces uncontrolled cellular proliferation leading to the development of tumor. Mutations of the p53 gene were found in various human cancers including hematologic malignancies. The incidence of the p53 mutation in acute myelogenous leukemia was reported to be relatively low, however, there has been no report as to the incidence and the characteristics of the p53 mutation in acute myelogenous leukemia in Korea. METHODS: Polymerase chain reaction and single strand conformational polymorphism(PCR-SSCP) was done to screen abnormal band shifts in exons 5, 6, 7, 8 of p53 gene in myeloid blasts obtained from bone marrow aspirates at the time of diagnosis from patients with de novo acute myelogenous leukemia. Mutation of the p53 gene was confirmed by direct sequencing with Sanger method in the DNAs with abnormal band shifts. Cytogenetic analysis of the bone marrow was performed by G-banding method. RESULTS: Only 1(2%) out of 48 patients with acute myelogenous leukemia showed abnormal band shift in exon 5 with PCR-SSCP. Base sequence of exon 5 of this patient with normal karyotype was found to have silent mutation at codon 143 from GTG(valine) to GTA(valine). He had acute myelogenous leukemia of M6 subtype and the leukemia was refractory to two cycles of standard induction chemotherapy, succumbed to death at last. CONCLUSION: Mutation of the p53 gene was found to be very rare in acute myelogenous leukemia in Korea and it was thought to be involved in leukemogensis only in some patients.
Base Sequence ; Bone Marrow ; Cell Cycle ; Cell Proliferation ; Codon ; Cytogenetic Analysis ; Diagnosis ; DNA ; Exons ; Genes, p53* ; Genes, Tumor Suppressor ; Hematologic Neoplasms ; Humans ; Incidence ; Induction Chemotherapy ; Karyotype ; Korea ; Leukemia ; Leukemia, Myeloid, Acute* ; Polymerase Chain Reaction