• Felipe Teran, Michael I Prats, Bret P Nelson, Ross Kessler, Michael Blaivas, Mary Ann Peberdy, Sasha K Shillcutt, Robert T Arntfield, and David Bahner.
• Division of Emergency Ultrasound and Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: felipe.teran-merino@pennmedicine.upenn.edu.
• J. Am. Coll. Cardiol. 2020 Aug 11; 76 (6): 745-754.

AbstractFocused transthoracic echocardiography (TTE) during cardiac arrest resuscitation can enable the characterization of myocardial activity, identify potentially treatable pathologies, assist with rhythm interpretation, and provide prognostic information. However, an important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. Over the last decade, focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis-those in cardiac arrest and periarrest states. In addition to the same diagnostic and prognostic role provided by TTE images, TEE provides unique advantages including the potential to optimize the quality of chest compressions, shorten cardiopulmonary resuscitation interruptions, guide resuscitative procedures, and provides a continuous image of myocardial activity. This review discusses the rationale, supporting evidence, opportunities, and challenges, and proposes a research agenda for the use of focused TEE in cardiac arrest with the goal to improve resuscitation outcomes.Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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