Quality Assurance for Intraoperative Transesophageal Echocardiography Monitoring

Abstract

We evaluated our experience with 846 consecutive transesophageal echocardiography (TEE) intraoperative monitoring procedures performed between November 1989 and July 1991. TEE frequency was 36 +/- 11 per month (range 16-55) and represented 69.8% of cardiac valve surgery cases, 40.2% of coronary artery bypass graft cases, and 2.2% of total operative caseload. Major patient complications consisted of transient vocal cord paresis and ingestion of glutaraldehyde-disinfectant solution. Minor complications consisted of a chipped tooth (one case) and pharyngeal abrasions (three cases). The Quality Assurance (Q/A) Program evaluated both record keeping and quality of imaging, as judged by cardiologist echocardiographer reviewers. The percentage of completion for each Q/A indicator was as follows: medical record documentation, 88%; database form annotation, 94%; and provision of videotape recording, 91%. TEE database forms were analyzed further in terms of the percentage of fields completed. Completion scores were 73%. The following scoring system was utilized for videotape evaluation by the cardiologists: 1 = excellent; 2 = good; 3 = poor. The median grade for both two-dimensional echocardiography and color flow Doppler (CFD) examinations was 2. Poor quality images (grade 3) were present in 15.2% of two-dimensional echocardiography and 20.3% of color flow Doppler examinations, and disproportionately associated with 4/26 attendings. Supplemental audit of the cardiology reviewers performance demonstrated 569/846 videotapes showed no objective evidence of review. The cardiology reviewer forms of the remaining 277 videotapes were evaluated in terms of the percentage of fields completed. The completion score was 56%. These data suggest the need for formal Q/A for intraoperative TEE, both for anesthesiologists and reviewing cardiologists.

Intraoperative Transoesophageal Echocardiography: Impact on Adult Cardiac Surgery

“…Increasing availability of TOE may also allow decreased use of pulmonary catheterization with its associated complications [23][24][25] . Additionally, in the near future, application of myocardial contrast echocardiography may further increase the utility of intraoperative TOE by allowing direct confirmation of coronary revascularization and cardioplegia delivery 26 .…”

Complications related to intraoperative transesophageal echocardiography in liver transplantation

“…An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography 2010 ). Studies have reported that TEE significantly improved the intraoperative management of patients undergoing OLT (Suriani et al 1996 ; Rafferty et al 1993 ). One study, although not conducted during intraoperative OLT procedures, showed that “TEE without transgastric views can be performed without serious complications in patients with grade I or II esophageal varices who have not experienced recent variceal hemorrhages”(Spier et al 2009 ).…”

Monitorización hemodinámica intraoperatoria con ecocardiografía transesofágica: Experiencia clínica

“…Además, no todos los cambios de la motilidad de la pared ventricular corresponden a isquemia: bloqueos en la conducción y el uso de inótropos pueden producirlos. Otra restricción de tipo técnico se plantea en cuanto a la imposibilidad de mantenerlo en el postoperatorio, por ser muy mal tolerado por el paciente [31][32][33] .…”