{"pk":18440,"title":"Performance of Intra-arrest Echocardiography: A Systematic Review","subtitle":null,"abstract":"<b>Introduction:</b> 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.<p></p><p><b>Methods:</b> 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.</p><p></p><p><b>Results: </b>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.</p><p></p><p><b>Conclusion:</b> 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.</p>","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"cardiac arrest"},{"word":"resuscitation"},{"word":"transthoracic echocardiography"},{"word":"Transesophageal echocardiography."}],"section":"Cardiology","is_remote":true,"remote_url":"https://escholarship.org/uc/item/775094ks","frozenauthors":[{"first_name":"Yi-Ju","middle_name":"","last_name":"Ho","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Chih-Wei","middle_name":"","last_name":"Sung","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hsin-Chu Hospital, Department of Emergency Medicine, Hsinchu, Taiwan","department":"None"},{"first_name":"Yi-Chu","middle_name":"","last_name":"Chen","name_suffix":"","institution":"National Taiwan University, Institute of Epidemiology and Preventive Medicine, College of Public Health, Taipei, Taiwan","department":"None"},{"first_name":"Wan-Ching","middle_name":"","last_name":"Lien","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Wei-Tien","middle_name":"","last_name":"Chang","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Chien-Hua","middle_name":"","last_name":"Huang","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan","department":"None"}],"date_submitted":"2023-08-22T03:22:46Z","date_accepted":"2023-08-22T03:22:46Z","date_published":"2024-02-09T14:00:00Z","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18440/galley/9601/download/"},"galleys":[{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18440/galley/9601/download/"}]}