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Role of emergency intraoperative transesophageal echocardiography
1Department of Anesthesiology, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
Insights
Emergency transesophageal echocardiography (TEE) is crucial for diagnosing critically ill patients. This study highlights TEE
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Transesophageal echocardiography (TEE) is vital for cardiovascular disease management in critically ill patients and during cardiac surgery.
- The diagnostic utility and clinical impact of emergency intraoperative TEE remain under-evaluated.
Purpose of the Study:
- To review the indications, findings, and clinical impact of emergency intraoperative TEE in a surgical patient cohort.
- To assess the effectiveness of TEE in guiding surgical management and improving outcomes.
Main Methods:
- Retrospective review of 66 patients undergoing emergency intraoperative TEE over a 4-year period.
- Analysis of indications, echocardiographic findings, and subsequent clinical decisions.
Main Results:
- New diagnostic findings were identified in 80% of patients (53/66).
- TEE led to alterations in planned surgical procedures in 23% of cases (15/66).
- Despite therapeutic impact, 36% of patients (24/66) did not survive.
Conclusions:
- Emergency intraoperative TEE is recommended for unexplained hemodynamic instability, urgent surgical evaluations, suspected trauma-related cardiac injury, and hypoxemia.
- TEE significantly impacts clinical management, but patient survival remains a concern.
Abstract:
Transesophageal echocardiography (TEE) has a definitive role in the diagnosis and management of critically ill patients with cardiovascular disease and patients undergoing cardiac operations. The diagnostic role of emergency intraoperative TEE and the impact on clinical outcome have not been evaluated. We reviewed the indications, findings, and impact of emergency intraoperative TEE in 66 patients over a 4-year period. The indications for emergency TEE were unexplained hemodynamic instability (36 patients), preoperative evaluation of patients having emergency surgery (19 patients), cardiac evaluation of trauma cases (6 patients), and unexplained intraoperative hypoxemia (5 patients). New findings were disclosed in 53 (80%) patients, with an alteration of the planned surgical procedure in 15 (23%). Despite the therapeutic impact, 24 patients (36%) did not survive to hospital dismissal. We recommend that TEE be considered as the diagnostic tool of choice when surgical patients have unexplained hemodynamic instability, when time does not permit complete preoperative evaluation, when cardiovascular injury is suspected in a trauma patient, and to evaluate unexplained hypoxemia.