Transesophageal echocardiography during cardiopulmonary arrest in the emergency department

Management of patients in cardiopulmonary arrest is challenging and can be resource consuming. Outcomes continue to be poor and physicians may feel a sense of futility when running a resuscitation. Bedside ultrasound has been utilized to guide resuscitations, diagnose correctable cardiac pathology leading to an arrest and has proved to have a prognostic value when utilized in the initial stages of resuscitation. Bedside emergency ultrasound is limited by inability to scan during chest compression and poor image quality in obese patients and those with emphysema. During cardiopulmonary resuscitation pulse checks need to be rapid and leave little time for transducer manipulation during image acquisition. Recent American Heart Association guidelines further stress the need for quality chest compressions and minimizing intervals with no compressions. Transesophageal echocardiography offers high resolution and clarity of images in the vast majority of patients. It allows for constant visualization of the heart, even during chest compressions, cardioversion and other procedures. This case series describes the use of transesophageal echocardiography (TEE) during cardiac arrest by emergency physicians. The cases illustrate some of the potential benefits of TEE during cardiopulmonary arrest.