Transesophageal Echocardiography Performed by Intensivist and Emergency Physicians—A 5-Year, Single-Center Experience

Abstract

Purpose: Data on the use of transesophageal echocardiography (TEE) by intensivist physicians (IP) and emergency physicians (EP) are limited. This study aims to characterize the use of TEE by IPs and EPs in critically ill patients at a single center in the United States. Materials and Methods: Retrospective chart review of all critical care TEEs performed from January 1, 2016 to January 31, 2021. The personnel performing the exams, location of the exams, characteristics of exams, complications, and outcome of the patients were reviewed. Results: A total of 396 examinations was reviewed. TEE was performed by IPs (92%) and EPs (9%). The location of TEE included: intensive care unit (87%), emergency department (11%), and prehospital (2%) settings. The most common indications for TEE were: hemodynamic instability/shock (44%), cardiac arrest (23%), and extracorporeal membrane oxygenation (ECMO) facilitation, adjustment, or weaning (21%). The most common diagnosis based on TEE were: normal TEE (25%), left ventricular dysfunction (19%), and vasodilatory shock (15%). A management change resulted from 89% of exams performed. Complications occurred in 2% of critical care TEEs. Conclusion: TEE can be successfully performed by IPs and EPs on critically ill patients in multiple clinical settings. TEE frequently informed management changes with few complications.

Echocardiography in cardiac arrest: strengths and limitations

“…Alike TTE, TEE allows to characterize the type of cardiac activity such as fine ventricular fibrillation, cardiac standstill, or pseudo PEA. Recently it has been documented that TEE can be feasibly performed in critically ill patients (cardiac arrest 23%) in different settings including the emergency department (11%) [3] by intensivists and emergency physicians, the latter after simulation-based training [4]. TEE seems to have the potential to increase CPR quality since it allows the identification of area of maximal compression in a single patient.…”

An Intensivist-Led Extracorporeal Membrane Oxygenation Program: Design, Implementation, and Outcomes of the First Five Years

“…21 Consequently, training and credentialing in the performance and interpretation of basic and advanced TEE by emergency physicians and intensivists was developed simultaneously with our ECLS program. 22 We utilize intensivist- and emergency medicine-performed TEE heavily to guide cannulation, cannula adjustment, and weaning from ECLS and in the assessment of patients during cardiac arrest. Alternatively, approximately 50% of our non-ECPR cannulations are guided by fluoroscopy, which is available using a portable C-arm in our ICUs.…”

Seeing the heart of the problem: transesophageal echocardiography in cardiac arrest: a practical review

“…33,53,63,64 However, the current body of literature consists primarily of small, single-center studies. [32][33][34]42,53,63,64 It remains unclear to what degree TEE-guided management changes improve patient-centered outcomes, including the key metric of neurologically intact survival. As evidence of useful management changes based on periarrest TEE emerges, weighed against a low complication rate, it may be expected that the use of TEE in CA will increase.…”

“…During cardiac surgery, the risk of the above complications ranges from 0.09% to 1.2%, 50,51 which is below the rate of 3% in patients undergoing TEE for structural heart intervention 52 . In the general critical care population, the complication rate of TEE may range from 1% to 4%, according to 2 single-center studies 53,54 . However, in these studies, the complication rate for TEE performed specifically for CA was as high as 4.3% 53 and included oropharyngeal and gastrointestinal bleeding.…”