Canadian Journal of Cardiology

Transesophageal Echocardiography in Cardiac Arrest: the Heart and Beyond

Published:January 05, 2023DOI:


      Point-of-care ultrasound (POCUS) involves different ultrasound modalities and is useful to assist management in emergent clinical situations such as cardiac arrest. The use of POCUS in cardiac arrest has mainly been described using transthoracic echocardiography (TTE) both as a diagnostic and prognostic tool. However, cardiac evaluation using TTE may be challenging due to patient-related or technical factors. Furthermore, its use during pulse check pauses has been associated with delays in chest compression resumption. Transesophageal echocardiography (TEE) overcomes these limitations by providing reliable and continuous imaging of the heart without interfering with cardiopulmonary resuscitation (CPR). In this narrative review we describe the role of TEE during CPR in four different applications: (1) Chest compression quality feedback; (2) Rhythm characterization; (3) Diagnosis of reversible causes and (4) Procedural guidance. Considering its own limitations, we propose an algorithm for the integration of TEE in cardiac arrest focusing on these four applications and extending its reach to extra-cardiac applications.
      Glossary: 2C (two-chamber), 4C (four-chamber), ACLS (Advanced Cardiovascular Life Support), AHA (American Heart Association), AMC (area of maximal compression), Ao (aorta), AbdoAo (abdominal aorta), AscAo (ascending aorta), AoV (aortic valve), ASD (atrial septal defect), CFD (color flow Doppler), CPR (cardiopulmonary resuscitation), CVP (central venous pressure), DescAo (descending aorta), ECG (electrocardiogram), ECPR (extracorporeal cardiopulmonary resuscitation), ED (emergency department), IAS (interatrial septum), ICU (intensive care unit), IO (intra-osseous), IV (intravenous), IVS (interventricular septum), L (left), LA (left atrium), LAA (left atrial appendage), LAX (long axis), LV (left ventricle or ventricular), LVOT (left ventricular outflow tract), ME (mid-esophageal), MV (mitral valve), OR (operating room), PA (pulmonary artery), PE (pulmonary embolism), PEff (pericardial effusion), PEA (pulseless electrical activity), PFO (patent foramen ovale), POCUS (point-of-care ultrasound), PV (pulmonic valve), R (right), RA (right atrium), r/o (rule out), ROSC (return of spontaneous circulation), RV (right ventricle or ventricular), RVOT (right ventricular outflow tract), RWMA (regional wall motion abnormalities), SAX (short axis), SVC (superior vena cava), TEE (transesophageal echocardiography), TELUS (transesophageal lung ultrasonography), TG (transgastric), TGAUS (transgastric abdominal ultrasonography), TTE (transthoracic echocardiography), TV (tricuspid valve), US (ultrasound), VF (ventricular fibrillation), VT (ventricular tachycardia)
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