Point-of-Care Transesophageal Echocardiography in Emergency and Intensive Care: An Evolving Imaging Modality

Transesophageal echocardiography (TEE) has long been established as a cornerstone imaging modality in cardiac surgery and perioperative medicine. In recent years, however, its role has expanded into emergency and intensive care settings, where rapid and accurate hemodynamic assessment is crucial for survival. Point-of-care TEE provides advantages over transthoracic echocardiography when acoustic windows are limited, particularly in mechanically ventilated or critically unstable patients, allowing continuous high-quality visualization of cardiac function, volume status, and great vessel pathology to guide immediate therapeutic interventions. This narrative review examines the evolving role of TEE in acute settings, with emphasis on its application in shock, cardiac arrest, pulmonary embolism, tamponade, and its value in extracorporeal membrane oxygenation (ECMO) cannulation. Advances such as three-dimensional TEE, miniaturized probes, and the integration of artificial intelligence are also discussed, as potential drivers of innovation. While bridging technological progress with clinical practice, TEE emerges as a versatile tool in critical care. However, its broader adoption is still limited by probe availability, operator training, and institutional resources. Overcoming these barriers will be essential to translating technological advances into widespread practice.