Out-of-Hospital Transesophageal Echocardiogram for Cardiac Arrest Resuscitation: The Initial Case

Merlin, Mark A.; Joseph, Joslyn; Hohbein, Janae; Ariyaprakai, Navin; Tanis, James; Tagore, Ammundeep

doi:10.1080/10903127.2019.1604926

Cited by 10 publications

(4 citation statements)

References 11 publications

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“…3 Further, TEE has been shown to change management when performed by an emergency physician (EP) in patients presenting to the emergency department (ED) during and immediately after cardiac arrest, [4][5][6][7] and its application has recently been expanded to the prehospital environment. 8,9 While TEE has long been viewed as safe in the perioperative [10][11] and elective 12 settings, there is less evidence in regard to the safety of TEE among patients in the intensive care unit (ICU). Arntfield et al 2 found no complications in their study of 274 IP-performed TEEs in critically ill patient population.…”

Section: Introductionmentioning

confidence: 99%

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Safety of Transesophageal Echocardiography Performed by Intensivists and Emergency Physicians in Critically Ill Patients With Coagulopathy and Thrombocytopenia: A Single-Center Experience

Wray

Schmid

Braude

et al. 2019

J Intensive Care Med

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Introduction: The use of transesophageal echocardiography (TEE) by intensivist physicians (IPs) and emergency physicians (EPs) in critically ill patients is increasing in the intensive care unit, emergency department, and prehospital environments. Coagulopathy and thrombocytopenia are common in critically ill patients. The risk of performing TEE in these patients is unknown. The goal of this study was to assess whether TEE is safe when performed by IPs or EPs in critically ill patients with high bleeding risk (HBR). Methods: All TEEs performed by an IP or EP between January 1, 2016, and July 31, 2019, were reviewed as part of a quality assurance database. A TEE performed on a patient was deemed HBR if the patient met at least one of the following criteria: undergoing therapeutic anticoagulation, had an INR > 2, activated partial thromboplastin time >40 seconds, fibrinogen <150 mg/dL, and/or platelet count <50 000/μL. The medical record was reviewed on each patient to determine whether upper esophageal bleeding, oropharyngeal bleeding, esophageal perforation, or dislodgement of an artificial airway occurred during or after the TEE. Results: A total of 228 examinations were reviewed: 80 in the high-risk group and 148 in the low-risk group (LBR). There were complications potentially attributable to TEE in 8 (4%) of the 228 exams. Total complications were not different between groups: 4 (5%) in the HBR group versus 4 (3%) in the LBR group (odds ratio [OR] = 1.89 [0.34-10.44], P =.368). Upper esophageal bleeding occurred in 5 total examinations (2%), which was not different between groups: 3 (4%) in the HBR group and 2 (1%) in the LBR group (OR = 2.84 [0.31-34.55], P = .238). There were no deaths attributable to TEE in either group. Conclusion: Transesophageal echocardiography can be safely performed by IPs and EPs in critically ill patients at high risk of bleeding with minimal complications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of Transesophageal Echocardiography Performed by Intensivists and Emergency Physicians in Critically Ill Patients With Coagulopathy and Thrombocytopenia: A Single-Center Experience

Wray

Schmid

Braude

et al. 2019

J Intensive Care Med

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“…13 Not surprisingly, the use in critically ill patients is increasing in the intensive care unit, 11,14 operating room, 15 emergency department, 16 and even prehospital settings. 17,18 "Rescue TEE" (TEE performed to rapidly assess for the cause of hemodynamic instability, sometimes also known as "resuscitative TEE") is particularly useful in the setting of CA. In the intra-arrest and periarrest setting, TEE has the ability to rapidly inform and guide management decisions while avoiding the limitations and interruptions in care that may occur with TTE.…”

mentioning

confidence: 99%

“…As such, TEE is recommended by the American Society of Echocardiography (ASE) in critically ill patients with limited transthoracic views 13 . Not surprisingly, the use in critically ill patients is increasing in the intensive care unit, 11,14 operating room, 15 emergency department, 16 and even prehospital settings 17,18 …”

mentioning

confidence: 99%