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. 2024 Mar;25(2):166-174.
doi: 10.5811/westjem.18440.

Performance of Intra-arrest Echocardiography: A Systematic Review

Yi-Ju Ho  1 , Chih-Wei Sung  1   2 , Yi-Chu Chen  3 , Wan-Ching Lien  1   4 , Wei-Tien Chang  1   4 , Chien-Hua Huang  1   4
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Performance of Intra-arrest Echocardiography: A Systematic Review

Yi-Ju Ho et al. West J Emerg Med. 2024 Mar.

Abstract

Introduction: Intra-arrest transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been introduced in adult patients with cardiac arrest (CA). Whether the diagnostic performance of TTE or TEE is superior during resuscitation is unclear. We conducted a systematic review following PRISMA guidelines.

Methods: We searched databases from PubMed, Embase, and Google Scholar and evaluated articles with intra-arrest TTE and TEE in adult patients with non-traumatic CA. Two authors independently screened and selected articles for inclusion; they then dual-extracted study characteristics and target conditions (pericardial effusion, aortic dissection, pulmonary embolism, myocardial infarction, hypovolemia, left ventricular dysfunction, and sonographic cardiac activity). We performed quality assessment using the Quality Assessment of Diagnostic Accuracy Studies Version 2 criteria.

Results: A total of 27 studies were included: 14 studies with 2,145 patients assessed TTE; and 16 with 556 patients assessed TEE. A high risk of bias or applicability concerns in at least one domain was present in 20 studies (74%). Both TTE and TEE found positive findings in nearly one-half of the patients. The etiology of CA was identified in 13% (271/2,145), and intervention was performed in 38% (102/271) of patients in the TTE group. In patients who received TEE, the etiology was identified in 43% (239/556), and intervention was performed in 28% (68/239). In the TEE group, a higher incidence regarding the etiology of CA was observed, particularly for those with aortic dissection. However, the outcome of those with aortic dissection in the TEE group was poor.

Conclusion: While TEE could identify more causes of CA than TTE, sonographic cardiac activity was reported much more in the TTE group. The impact of TTE and TEE on the return of spontaneous circulation and further survival was still inconclusive in the current dataset.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This study received grant funding from the National Science and Technology Council, Taiwan (NSTC 112-2410-H-002-171). There are no other conflicts of interest or sources of funding to declare.

Figures

Figure.
Figure.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram.
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