• Laila Hussein, RehmanMohammad AnzalMADepartment of Emergency Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates., Tomislav Jelic, Alexei Berdnikov, Felipe Teran, Simon Richards, Nicole Askin, Robert Jarman, and SHoC Investigators and the Resuscitative TEE Collaborative Registry Investigators.
• Teesside University, Middlesbrough, United Kingdom; Department of Emergency Medicine, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates. Electronic address: lhussein@ssmc.ae.
• Resuscitation. 2021 Nov 1; 168: 167-175.

AimsTo 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.MethodsWe 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 clinicaltrials.gov 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.ResultsEleven 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.ConclusionDue 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.Copyright © 2021 Elsevier B.V. All rights reserved.

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