• Neil Krulewitz, Nicholas M Levin, Scott Youngquist, Christopher Kelly, Guillaume Hoareau, Michael Austin Johnson, and Patrick Ockerse.
• University of Vermont, Department of Emergency Medicine, Burlington, VT, United States of America. Electronic address: Neil.Krulewitz@UVMhealth.org.
• Am J Emerg Med. 2023 Dec 1; 74: 141614-16.

ObjectiveTransesophageal echocardiography (TEE) is becoming increasingly utilized by emergency medicine providers during cardiac arrest. Intra-arrest, TEE confers several benefits including shorter pauses in chest compressions and direct visualization of cardiac compressions. Many ultrasound probe manufacturers recommend against performing defibrillation with the TEE probe in the mid-esophagus for fear of causing esophageal injury or damage to the probe, however no literature exists that has investigated this concern. To assess this, we performed cardiopulmonary resuscitation (CPR) and multiple defibrillations in 8 swine with a TEE probe in place.MethodsWe performed TEE on 8 adult swine during CPR and performed multiple 200 J defibrillations with the TEE probe in the mid-esophagus. Post-mortem, esophagi were dissected and inspected for evidence of injury.ResultsOn macroscopic inspection of 8 esophagi, no evidence of hematoma, thermal injury, or perforation was noted.ConclusionOur study suggests that performing defibrillation during CPR with a TEE probe in place in the mid-esophagus is likely safe and low risk for significant esophageal injury. This further bolsters the use of TEE in CPR and would enable continuous visualization of cardiac activity without the need to remove the TEE probe for defibrillation.Copyright © 2023 Elsevier Inc. All rights reserved.

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