Transesophageal Echocardiography in Cardiac Arrest: the Heart and Beyond.

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.