Transoesophageal echocardiography during cardiopulmonary resuscitation for cardiac arrest: a scoping review.

BACKGROUND

Transoesophageal echocardiography (TEE) enables continuous cardiac imaging during cardiopulmonary resuscitation (CPR) without interrupting chest compressions, but its impact on patients' outcomes remains uncertain. We performed a scoping review to comprehensively map the evidence on intra-arrest TEE in cardiac arrest.

METHODS

We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov, and grey literature from inception to March 2026. Studies evaluating TEE during CPR in adults with in- or out-of-hospital cardiac arrest were included. Outcomes comprised survival, neurological status, return of spontaneous circulation, CPR quality metrics, diagnostic findings, impact on management, feasibility, and safety.

RESULTS

Twenty-two studies including 1254 patients (84% out-of-hospital cardiac arrest) were identified; most were single-centre observational studies without comparators. Two randomized trials reported no difference between TEE-guided and conventional CPR in return of spontaneous circulation, survival, or favourable neurological outcome. Observational data suggested associations between TEE-defined compression location and outcomes, with compressions over the left ventricular outflow tract or aortic valve associated with less frequent return of spontaneous circulation and short-term survival. TEE-guided modification of chest compression position occurred in 19-76% of cases. TEE influenced management in 31-48% of patients and identified potential arrest aetiology in 20-86%. TEE was associated with shorter pauses compared with transthoracic echocardiography. Feasibility was high (successful insertion 80-100%), with few reported complications. Knowledge gaps include lack of long-term outcomes, standardized protocols, and evidence on safety and effectiveness across different clinical settings.

CONCLUSIONS

Intra-arrest TEE appears feasible and frequently alters resuscitation management, but current evidence does not demonstrate improved patient-centred outcomes. Further studies are required to inform appropriate integration into resuscitation practice.