Transesophageal echocardiography during cardiac arrest in the emergency department

Echocardiography represents a central element in the diagnosis of patients in emergency and intensive care medicine. Transesophageal echocardiography (TEE), in contrast to transthoracic echocardiography (TTE), can be performed independently of patient habitus, ventilation, and positioning, thus, consistently providing good image quality. Relevant pathologies and reversible causes of cardiac arrest (e.g., pulmonary artery embolism, pericardial tamponade) can be quickly diagnosed and, thus, amenable to treatment. In addition, during cardiopulmonary resuscitation, uninterrupted chest compressions are ensured and there is no diagnosis-related prolongation of the no-flow-time. Some TEE studies also describe its utility as a diagnostic tool for determining resuscitation in the absence of mechanical cardiac activity. Implantation and repositioning of cannulation of circulatory support systems (e.g., extracorporeal life support, ECLS) represent other applications of TEE. In summary, TEE represents a safe, rapidly learnable, and superior tool compared to TTE for the diagnosis of shock room patients and during cardiopulmonary resuscitation. This review is intended to present the indications, advantages, and potential risks of TEE in the context of the care of critically ill trauma room patients and under resuscitation conditions.