Over the last decade, focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis—those in cardiac arrest and periarrest states. In addition to the same diagnostic and prognostic role provided by TTE images, TEE provides unique advantages including the potential to optimize the quality of chest compressions, shorten cardiopulmonary resuscitation interruptions, guide resuscitative procedures, and provides a continuous image of myocardial activity.
Further Reading:
1. Teran F et al. Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. JACC 2020
2. Beaulac et al. Transesophageal Echocardiography in Cardiac Arrest: the Heart and Beyond. Canadian Journal of Cardiology 2023
3. Prager et al. Critical Care Transesophageal Echocardiography for the Resuscitation of Shock. Chest 2022
Recommended TEE Views in Cardiac Arrest
1. ME 4C
Applications:
- Rule out tamponade
- Assess cardiac activity
- Identify intracardiac thrombus
- Assess LV/RV size and function
- Detect fine VF
2. ME LAX
- Assess proximal ascending aorta
- Assess AMC during CPR
3. TG SAX
Applications:
- Assess cardiac activity
- LV/RV size and function, cardiac filling status
- presence of tamponade
4. ME BICAVAL
Applications:
- Procedural guidance (ECMO, CVC)
- Volume responsiveness in post-arrest, intracardiac thrombus
5. Desc Thoracic Ao LAX
Applications:
- Procedural guidance – ECMO, IABP