Abstract
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.
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Article info
Publication history
Accepted:
December 27,
2022
Received in revised form:
December 27,
2022
Received:
September 8,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Brief Summary
Point-of-care ultrasound in cardiac arrest is of growing interest and its application mainly involves transthoracic echocardiography. Considering the technical limitations and potential prolongation of chest compression interruptions when a transthoracic approach is used, this narrative review aims to describe the evolving role of transesophageal echocardiography (TEE) in cardiac arrest resuscitation. Integrating TEE extra-cardiac applications, our proposed algorithm focuses on chest compression feedback, rhythm characterization, diagnosis of reversible causes and procedural guidance.
Financial Disclosure
A.Y. Denault supported by the Montreal Heart Institute Foundation and Richard I. Kaufman Endowment Fund in Anesthesia and Critical Care. The funding sources had no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.
Conflicts of Interest
A.Y. Denault is a speaker and consultant for CAE Healthcare and speaker for Edwards and Masimo. He received a research grant from Edwards (2019).
F. Teran is a speaker and consultant for Fujifilm Sonosite, is the founder and course director of the Resuscitative TEE Workshop, and the Scientific Oversight Committee Chair for the Resuscitative TEE Collaborative Registry.
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