Transoesophageal echocardiography in cardiac arrest: A systematic review

On behalf of the SHoC Investigators and the Resuscitative TEE Collaborative Registry Investigators, Laila Hussein, Mohammad Anzal Rehman, Tomislav Jelic, Alexei Berdnikov, Felipe Teran, Simon Richards, Nicole Askin, Robert Jarman

Research output: Contribution to journalReview articlepeer-review

5 Citations (Scopus)


Aims: To identify, appraise and synthesize all available clinical evidence to evaluate the diagnostic role of transoesophageal echocardiography (TEE) during resuscitation of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) in the identification of reversible causes of cardiac arrest and cardiac contractility. Methods: We conducted a systematic review following PRISMA guidelines. Medline, EMBASE, Web of Science Core Collection, Proquest Dissertations, Open Grey, CDSR, Cochrane Central, Cochrane Clinical Answers, and the registry were searched for eligible studies. Studies involving adult patients, with non-traumatic cardiac arrest in whom TEE was used for intra-arrest evaluation, were included. Case studies and case series, animal studies, reviews, guidelines and editorials were excluded. The QUADAS-2 tool was used for quality assessment of all studies. Results: Eleven studies with a total of 358 patients were included. Four studies involved perioperative IHCA, three involved OHCA, and four were mixed population settings. Overall, the risk of bias in the selected studies was either high or unclear due to evidence or lack of information. In all 11 studies, TEE allowed the identification of reversible causes of arrest. We found significant heterogeneity in the criteria used to interpret findings, TEE protocol used, and timing of TEE. Conclusion: Due to heterogeneity of studies, small sample size and inconsistent reference standard, the evidence for TEE in cardiac arrest resuscitation is of low certainty and is affected by a high risk of bias. Further studies are needed to better understand the true diagnostic accuracy of TEE in identifying reversible causes of arrest and cardiac contractility.

Original languageEnglish
Pages (from-to)167-175
Number of pages9
Publication statusPublished - 11 Aug 2021

Bibliographical note

Funding Information:
Andrew Nashed, Rady Faculty of Health Sciences - University of Manitoba, has contributed to the study selection and data extraction of this systematic review. Maureen Babb, MLIS, University of Manitoba, has peer reviewed the MEDLINE search strategy.

Publisher Copyright:
© 2021 Elsevier B.V.


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