Transoesophageal echocardiography during cardiopulmonary resuscitation for cardiac arrest: A scoping review.

Authors

Tommaso Scquizzato, Carolyn M Zelop, David Purkarthofer, Anna Mara Scandroglio, Natalie Kruit, Richard McGowan, Felipe Teran, Katherine Berg, Ari Moskowitz, Ian R Drennan, International Liaison Committee on Resuscitation Advanced Life Support Task Force

Published in

Resuscitation. Pages 111261. Aug 15, 2026. Epub Aug 15, 2026.

Abstract

Transoesophageal echocardiography (TEE) enables continuous cardiac imaging during cardiopulmonary resuscitation (CPR) without interrupting chest compressions, but its impact on patients' outcomes remains uncertain. We performed a scoping review to comprehensively map the evidence on intra-arrest TEE in cardiac arrest.
We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov, and grey literature from inception to March 2026. Studies evaluating TEE during CPR in adults with in- or out-of-hospital cardiac arrest were included. Outcomes comprised survival, neurological status, return of spontaneous circulation, CPR quality metrics, diagnostic findings, impact on management, feasibility, and safety.
Twenty-two studies including 1,254 patients (84% out-of-hospital cardiac arrest) were identified; most were single-centre observational studies without comparators. Two randomized trials reported no difference between TEE-guided and conventional CPR in return of spontaneous circulation, survival, or favourable neurological outcome. Observational data suggested associations between TEE-defined compression location and outcomes, with compressions over the left ventricular outflow tract or aortic valve associated with less frequent return of spontaneous circulation and short-term survival. TEE-guided modification of chest compression position occurred in 19-76% of cases. TEE influenced management in 31-48% of patients and identified potential arrest aetiology in 20-86%. TEE was associated with shorter pauses compared with transthoracic echocardiography. Feasibility was high (successful insertion 80-100%), with few reported complications. Knowledge gaps include lack of long-term outcomes, standardized protocols, and evidence on safety and effectiveness across different clinical settings.
Intra-arrest TEE appears feasible and frequently alters resuscitation management, but current evidence does not demonstrate improved patient-centred outcomes. Further studies are required to inform appropriate integration into resuscitation practice.

PMID:
42603603
Bibliographic data and abstract were imported from PubMed on 16 Aug 2026.

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