The influence of transoesophageal echocardiography on intra‐operative decision makingA European multicentre study

Abstract

SummaryThe role of transoesophageal echocardiography (TOE) in anaesthesia remains controversial because it is a rapidly evolving technique with few proven benefits and considerable cost. Recently, the Society of Cardiovascular Anaesthesiologists has published practice guidelines for the use of peri-operative TOE. To determine the current role of transoesophageal echocardiography and the relative impact of category-based transoesophageal echocardiographic indications the present study investigated its use in seven Western European countries. The study sample was taken from a prospective cohort of 224 patients with acute or chronic haemodynamic disturbances or at risk of myocardial ischaemia. All patients were monitored with two-lead electrocardiography and radial and pulmonary artery catheters, as well as biplane or multiplane transoesophageal echocardiography. A total of 2232 clinical interventions were made in these patients. The most frequently observed intervention was the administration of a fluid bolus (45% of all interventions). Overall, transoesophageal echocardiography was the most important guiding factor in 560 (25%) interventions. It was the most important monitor in guiding the following therapeutic interventions: anti-ischaemic therapy -207 of 372 interventions (56%); fluid administration -275 of 996 (28%) interventions; vasopressor or inotrope administration -56 of 316 (16%) interventions; vasodilator therapy -six of 142 (4%) interventions and depth of anaesthesiafour of 211 (2%) interventions. We found that transoesophageal echocardiography is frequently influential in guiding clinical decision making and is used most frequently for category II indications but category I indications were associated with more frequent change in management.

Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery

“…Although, the impact was lower in our study, their results are in agreement with our observations, resulting in 30% change in overall management, with a greater impact in category I than in category II indication. 9 Our results documented that, in a larger group of patients obtained in a single centre, the routine use of TEE often has a strong influence on intraoperative clinical decision making in cardiac surgery.…”

“…Another study has also evaluated the influence of transesophageal echocardiography on intraoperative decision making. 9 This European study included 224 patients, undergoing cardiac and noncardiac surgery, from nine participating centres. Results from multicentre trials may have limitations because results may differ among institutions, due to differences in patient population, surgical technique or training of anesthesiologists among the centres.…”

“…7 Although these guidelines are generally accepted, their usefulness in the clinical management of patients undergoing cardiac surgery has been evaluated only in a few studies. 9 The purpose of this study was to review the clinical impact of perioperative TEE in our clinical practice and to determine the usefulness of categorybased TEE indications.…”

Perioperative use of transesophageal echocardiography by anesthesiologists: Impact in noncardiac surgery and in the intensive care unit

“…Kolev studied the influence of TEE on intraoperative decision making using the ASA guidelines. 3 This European study included 224 patients, undergoing cardiac and noncardiac surgery, from nine participating centres. Our results are in agreement with their observations, resulting in a 30% change in overall management, with a greater impact in category I than category II.…”

“…1 It appears from these guidelines that the impact of TEE will occur mostly during cardiac surgery. However, there is a growing interest in the use of TEE by the anesthesiologist in the noncardiac surgical setting 2,3 and in the intensive care unit (ICU). 4 The impact of TEE and the noncardiac procedures which are most likely to benefit from this monitoring technique are not well defined.…”