Patterns of use and influence of goal-directed transesophageal echocardiography in critically ill patients: a single centre, retrospective review
CCCF ePoster library. Ahsan S. Oct 27, 2015; 114766; P55
Dr. Shoeb Ahsan
Dr. Shoeb Ahsan
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Topic: Retrospective or Prospective Cohort Study

Patterns of use and influence of goal-directed transesophageal echocardiography in critically ill patients: a single centre, retrospective review

Shoeb Ahsan, R. Arntfield

Medicine, Western University, London, Canada | Medicine, Division of Critical Care, Western University, London, Canada

Introduction: Point-of-Care (POC) transthoracic echocardiography (TTE) is recommended as a core skill for physicians managing circulatory failure (1,2). Transesophageal echocardiography (TEE) has several advantages over TTE but its use is typically reserved for those operators with advanced training (3). In life threatening circumstances, TEE use is often limited secondary to a lack of availability of trained providers or reliance on comprehensive examinations by consulting services. In these situations goal-directed TEE performed by acute care physicians at the POC may expedite diagnosis and management.

Objectives: We seek to analyze our local experience with goal-directed TEE performed at the POC and its impact on management in the emergency department (ED) and intensive care unit (ICU).

Methods: POC TEE capability was introduced at our institution in December 2012. All TEE exams and their reports were archived in a dedicated POC ultrasound imaging database. We conducted a search for all TEE examinations between December 2012 and April 2015 at our institution. The details regarding operator, location of the examination, indication and findings were abstracted and analyzed. Inclusion criteria were full documentation of TEE reports and scans performed at the POC in the ICU or ED. Management changes were considered to have taken place if any recommendation regarding initiation/escalation of inotropes, fluid administration, termination of management/resuscitation, surgical procedure or other intervention were suggested in the report.

Results: Our search yielded 229 goal-directed TEE examinations and 182 met inclusion criteria. TEE changed management in 63.1% of cases. The indications were for assessment of shock (40.0%), peri-arrest (29.2%), endocarditis (10.7%), LV function (8.7%), ECMO cannulation and management (8.2%) and other (6.2%). Management suggestions were fluids (25.4%), initiation/increase in inotropy (25.4%), procedural intervention (18.1%), termination of management/resuscitation (13.87%) or other (17.4%). 60.1% of studies were performed by physicians with formal TEE fellowship training (4 operators). The rest of cases were performed by physicians locally credentialed for goal directed TEE use by POC ultrasound director. Studies by fellowship trained physicians changed management in 61.7% of cases versus 63.6% amongst all other physicians.

Conclusion: Our local experience shows that goal directed TEE can alter patient management of the critically ill. Further studies are required to define outcomes and benefits of POC TEE.

References: 1. J Am Soc Echocardiogr 1999;12: 82-4.
2. Can Respir J. 2014; 21(6): 341–345.
3. Clin Cardiol. 1994;17(8): 438-44.
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