I’ll translate this article into English for you.<\/p>\n
A narrative review examines the why, how, when, and where of TEE during resuscitation \u2014 and what is still missing to justify widespread adoption<\/strong><\/p>\n When a patient is in cardiac arrest and the team is performing chest compressions, transthoracic echocardiography (TTE) \u2014 the most commonly used imaging tool \u2014 has a fundamental problem: it can only provide images during compression pauses, precisely when interruptions should be minimized. Transesophageal echocardiography (TEE), by placing the probe directly in the esophagus behind the heart, eliminates this constraint by enabling continuous imaging during compressions.<\/p>\n The concept is not new \u2014 TEE has been used in cardiac arrest since the 2000s. But its adoption remains limited to a handful of specialized centers, despite encouraging data on its ability to modify clinical decisions in real time. Vetrugno and collaborators present in this narrative review a comprehensive overview: why use TEE, how to perform it, who should practice it, and in which settings it is most relevant.<\/p>\n This review is relevant to our thinking on resuscitation quality improvement, even though TEE remains a niche tool that does not apply to the majority of in-hospital cardiac arrests.<\/p>\n Design:<\/strong> Narrative review (narrative synthesis) \u2014 neither systematic nor meta-analytic. The literature search covered PubMed\/MEDLINE, Scopus, and EMBASE for studies published between January 1990 and January 2025. Search terms included combinations of “transesophageal echocardiography” \/ “TEE” AND “cardiac arrest” \/ “CPR” AND “feasibility” \/ “safety” \/ “clinical impact.”<\/p>\n The authors did not perform quantitative pooling or formal risk-of-bias assessment, which is consistent with narrative review recommendations given the heterogeneity of the included studies.<\/p>\n Appraisal tool:<\/strong> No formal tool used (no AMSTAR 2, no PRISMA). The review does not follow a pre-registered protocol.<\/p>\n TEE offers several specific advantages over TTE during resuscitation:<\/p>\n Continuous imaging:<\/strong> Unlike TTE, which requires compression pauses to obtain usable images, TEE allows continuous visualization of ventricular morphology and function during chest compressions.<\/p>\n Diagnostic impact:<\/strong> In the Teran et al. study (33 patients in out-of-hospital cardiac arrest), TEE identified fine ventricular fibrillation in 4 patients (12%) initially considered to be in asystole, enabling earlier defibrillation. It also revealed 2 cases of pseudo-pulseless electrical activity (pseudo-PEA). Overall, TEE influenced intra-arrest clinical decisions in up to 78% of cases in some series.<\/p>\n CPR quality optimization:<\/strong> Hwang et al., in a cohort of 34 patients in non-traumatic cardiac arrest, showed that compressions caused narrowing of the left ventricular outflow tract (LVOT) or aortic root in 19\u201383% of cases, with stroke volume correlated to compression position. TEE potentially allows adjustment of the compression point to maximize generated cardiac output.<\/p>\n Reduction of compression interruptions:<\/strong> Fair et al. (139 pulse check pauses in 25 patients) demonstrated that TEE-guided pauses lasted an average of 9 seconds (95% CI 5\u201312 s), compared to 19 seconds for TTE (95% CI 16\u201322 s) and 11 seconds for manual palpation (95% CI 8\u201314 s).<\/p>\n Insertion takes less than 2 minutes in experienced hands. Standard positioning is at 35\u201340 cm, 0\u00b0 angle, to obtain a 4-chamber view allowing assessment of ventricular morphology during CPR. Simplified protocols such as “POCUS-TEE” (4 focused views) have been developed to enable adoption by emergency physicians and intensivists, beyond the cardiologists and anesthesiologists traditionally trained in the technique.<\/p>\n Feasibility data are encouraging: in a series of 183 out-of-hospital cardiac arrests, insertion failure occurred in only 3 patients (1.6%), with a single minor valvular injury (0.5%).<\/p>\n The authors propose a hierarchy by setting, illustrated by 4 clinical vignettes:<\/p>\n A critical point raised by the authors: the three main probe manufacturers (Philips, GE Healthcare, Sonosite) have not formally evaluated the electrical safety of their TEE systems during defibrillation. Current recommendations advise withdrawing the probe approximately 20 cm before each shock and immediately reinserting it afterward. In an animal study of 8 pigs (Krulewitz et al.), no thermal injury, hematoma, or perforation was observed after multiple defibrillations at 200 J with the probe in the mid-esophageal position.<\/p>\n What the review shows.<\/strong> TEE is technically feasible during cardiac arrest, with a high insertion success rate and a favorable complication profile. It provides continuous diagnostic information that TTE cannot offer during active compressions. Its potential for identifying reversible causes, optimizing compression position, and shortening pauses is well documented.<\/p>\n Why this matters \u2014 with caveats.<\/strong> For tertiary centers that already have the equipment and trained personnel (ECPR programs, cardiac operating rooms, intensive care units), TEE represents a logical complement to cardiac arrest management. The question is not whether TEE “works” technically, but whether it actually improves patient outcomes \u2014 and that question remains unanswered.<\/p>\n What could be misinterpreted.<\/strong> It would be premature to present TEE as an essential component of modern resuscitation for all hospitals. The vast majority of in-hospital cardiac arrests occur in contexts where TEE is neither available nor appropriate. The fundamentals of resuscitation \u2014 high-quality compressions, rapid defibrillation, minimization of interruptions, team coordination \u2014 remain the primary determinants of survival.<\/p>\n Canadian perspective.<\/strong> In the Quebec context, TEE in cardiac arrest primarily concerns university health centers and tertiary centers with ECPR\/ECMO programs. For the vast majority of CISSS\/CIUSSS institutions, the priority investment should remain compression quality, team-based training, and code blue response protocols \u2014 exactly what SCORE addresses.<\/p>\n “Transesophageal echocardiography represents a significant advancement in the management of patients experiencing cardiac arrest across all intensive care settings. [\u2026] However, its impact on patient-centered outcomes remains to be proven. Wider implementation will depend on validated training pathways, institutional support, and further prospective studies addressing safety, logistics, and cost-effectiveness.” (p. 9)<\/p>\n This narrative review offers a useful panorama of the current state of TEE in cardiac arrest. It will be a valuable reference for anesthesiologists, intensivists, and cardiologists seeking to develop this skill at their center.<\/p>\n For hospital decision-makers and quality improvement teams, the message is nuanced: TEE is a promising but niche tool whose impact on survival remains unproven. Before investing in a TEE program for cardiac arrest, institutions must first ensure that the fundamentals are mastered \u2014 and that is where the return on investment is highest.<\/p>\n In light of these data, here is what I would do in practice today: in a tertiary center with an ECPR program, I would explore integrating TEE into the cardiac arrest protocol, starting with cases occurring in the operating room and intensive care unit. But in a community hospital or a CISSS without an ECMO program, I would concentrate 100% of my resources on compression quality, team coordination, and post-resuscitation debriefing. TEE is a luxury as long as the fundamentals are not in place.<\/p>\n TEE offers continuous cardiac imaging during CPR, superior to TTE, and can modify clinical decisions in a significant proportion of cases. However, no data demonstrate improved survival. For the majority of hospitals, investments in CPR quality improvement, team coordination, and response protocols offer a better return on investment than adopting TEE.<\/p>\n <\/p>\n Statistical Legend<\/strong><\/p>\n I’ll translate this article into English for you. A narrative review examines the why, how, when, and where of TEE during resuscitation \u2014 and what is still missing to justify widespread adoption \ud83c\udfaf Key Points Transesophageal echocardiography (TEE) enables continuous, high-resolution cardiac imaging during chest compressions \u2014 a major advantage over transthoracic echocardiography (TTE), which […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"none","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","inline_featured_image":false,"footnotes":""},"categories":[38],"tags":[],"class_list":["post-3493","post","type-post","status-publish","format-standard","hentry","category-beyond-acls"],"_links":{"self":[{"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/posts\/3493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/comments?post=3493"}],"version-history":[{"count":1,"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/posts\/3493\/revisions"}],"predecessor-version":[{"id":3496,"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/posts\/3493\/revisions\/3496"}],"wp:attachment":[{"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/media?parent=3493"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/categories?post=3493"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/com-bos.ca\/en\/wp-json\/wp\/v2\/tags?post=3493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n\ud83c\udfaf Key Points<\/h2>\n
\n
\nIntroduction<\/h2>\n
\n\ud83d\udccb Study Profile<\/h2>\n
\n\n
\n \nField<\/th>\n Details<\/th>\n<\/tr>\n<\/thead>\n \n Reference<\/td>\n Vetrugno L, Deana C, Boero E, et al. J Anesth Analg Crit Care (2026) 6:18.<\/td>\n<\/tr>\n \n DOI<\/td>\n 10.1186\/s44158-025-00329-9<\/td>\n<\/tr>\n \n Study type<\/td>\n Narrative review<\/td>\n<\/tr>\n \n Sources<\/td>\n PubMed\/MEDLINE, Scopus, EMBASE (January 1990 \u2014 January 2025)<\/td>\n<\/tr>\n \n Journal<\/td>\n Journal of Anesthesia, Analgesia and Critical Care (impact factor: 2.96, Q2)<\/td>\n<\/tr>\n \n Funding<\/td>\n None. No conflicts of interest declared.<\/td>\n<\/tr>\n \n Retraction Watch<\/td>\n No retractions identified<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\nMethodology<\/h2>\n
\nResults \u2014 Summary of Key Data<\/h2>\n
Why Use TEE in Cardiac Arrest?<\/h3>\n
How to Use TEE and Who Should Practice It?<\/h3>\n
Where Is TEE Most Relevant?<\/h3>\n
\n\n
\n \nSetting<\/th>\n Relevance<\/th>\n Rationale<\/th>\n<\/tr>\n<\/thead>\n \n Operating room<\/td>\n Very high<\/td>\n TEE immediately available, trained personnel on site, TTE often impossible<\/td>\n<\/tr>\n \n Intensive care unit<\/td>\n High<\/td>\n Patient often already intubated, TEE often superior to TTE, trained personnel available<\/td>\n<\/tr>\n \n Emergency department<\/td>\n Moderate<\/td>\n Variable availability, TTE remains first choice, TEE useful when TTE is inadequate<\/td>\n<\/tr>\n \n Pre-hospital<\/td>\n Emerging<\/td>\n First clinical use recently documented, miniaturized probes promising<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Safety \u2014 A Significant Blind Spot<\/h3>\n
\nStrengths<\/h2>\n
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\nLimitations<\/h2>\n
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\nDiscussion<\/h2>\n
\nAuthors’ Conclusion<\/h2>\n
\nOur Conclusion (Com-Bos)<\/h2>\n
\n\ud83d\udc8a Clinical Bottom Line<\/h2>\n
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