Perioperative transesophageal echocardiography (TEE) has been part of clinical activity
for more than 40 years. During this period, TEE has evolved in terms of technology
and clinical applications beyond the initial fields of cardiology and cardiac surgery.
The benefits of TEE in the diagnosis and management of acute hemodynamic and respiratory
collapse have been recognized in noncardiac surgery and by other specialties too.
This natural progress led to the development of rescue TEE, a relatively recent clinical
application that extends the use of TEE and makes it accessible to a large group of
clinicians and patients requiring acute care. In this review, the authors appraise
the current clinical applications and evidence base around this topic. The authors
provide a thorough review of the various image acquisition protocols, clinical benefits,
and compare it with the more frequently used transthoracic echocardiography. Furthermore,
the authors have reviewed the current training and credentialing pathways. Overall,
rescue TEE is a highly attractive and useful point-of-care examination, but the current
evidence base is limited and the technical protocols, training, and credentialing
processes are not standardized. There is a need for adequate guidelines and high-quality
research to support its application as a bedside rescue tool.
Key Words
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References
- History of the evolution of echocardiography.Int J Cardiol. 2004; 97: 1-6
- Application of transesophageal echocardiography to continuous intraoperative monitoring of left ventricular performance.Am J Cardiol. 1980; 46: 95-105
- Guidelines for the use of transesophageal echocardiography to assist with surgical decision-making in the operating room: A surgery-based approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons.J Am Soc Echocardiogr. 2020; 33: 692-734
- Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography.Anesthesiology. 2010; 112: 1084-1096
- Transesophageal echocardiography in patients undergoing coronary artery bypass graft surgery.J Am Coll Cardiol. 2021; 78: 112-122
- ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.Anesth Analg. 1999; 89: 870-884
- The evolution of intraoperative transesophageal echocardiography.Mt Sinai J Med. 2002; 69: 18-20
- Evaluation of out-of-hospital cardiac arrest using transesophageal echocardiography in the emergency department.Resuscitation. 2019; 137: 140-147
- Transesophageal echocardiography (TEE) in cardiac arrest: Results of a hands-on training for a simplified TEE protocol.Ultrasound J. 2020; 12: 41
- The effect of perioperative rescue transesophageal echocardiography on the management of trauma patients.A A Case Rep. 2016; 6: 387-390
- Critical care transesophageal echocardiography in patients during the COVID-19 pandemic.J Am Soc Echocardiogr. 2020; 33: 1040-1047
- The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation.J Am Soc Echocardiogr. 2012; 25: 131-141
- Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice.Acad Emerg Med. 2022; 29: 334-343
- Simulator-based training for learning resuscitative transesophageal echocardiography.CJEM. 2019; 21: 523-526
- A review of 364 perioperative rescue echocardiograms: Findings of an anesthesiologist-staffed perioperative echocardiography service.J Cardiothorac Vasc Anesth. 2015; 29: 82-88
- Recommendations for echocardiography laboratories participating in cardiac point of care cardiac ultrasound (POCUS) and critical care echocardiography training: Report from the American Society of Echocardiography.J Am Soc Echocardiogr. 2020; 33 (e4): 409-422
- Basic perioperative transesophageal echocardiography examination: A consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.J Am Soc Echocardiogr. 2013; 26: 443-456
- Guidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.J Am Soc Echocardiogr. 2013; 26: 921-964
- Development of a rescue echocardiography protocol for noncardiac surgery patients.Anesth Analg. 2019; 129: e37-e40
- Guidelines for the use of transesophageal echocardiography (TEE) in the ED for cardiac arrest.Ann Emerg Med. 2017; 70: 442-445
- Use of rapid "rescue" perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients.J Cardiothorac Vasc Anesth. 2012; 26: 362-370
- Focused transesophageal echocardiography for emergency physicians-description and results from simulation training of a structured four-view examination.Crit Ultrasound J. 2015; 7: 27
- The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologists.Anesth Analg. 2001; 92: 1103-1110
- Perioperative transesophageal echocardiography for non-cardiac surgery.Can J Anaesth. 2018; 65: 381-398
- The usefulness of transesophageal echocardiography during intraoperative cardiac arrest in noncardiac surgery.Anesth Analg. 2006; 102: 1653-1657
- Utility of intraoperative transesophageal echocardiography for diagnosis of pulmonary embolism.Anesth Analg. 2004; 99: 12-16
- The ability of left ventricular end-diastolic volume variations measured by TEE to monitor fluid responsiveness in high-risk surgical patients during craniotomy: A prospective cohort study.BMC Anesthesiol. 2017; 17: 165
- Transesophageal echocardiography during cardiopulmonary arrest in the emergency department.Resuscitation. 2008; 78: 135-140
- The role of point-of-care ultrasound in the diagnosis of pericardial effusion: A single academic center retrospective study.Ultrasound J. 2021; 13: 2
- The importance of transesophageal echocardiography in diagnosis of pericardial tamponade after cardiac surgery.J Card Surg. 2008; 23: 450-453
- Evaluation of the application of the ACCF/ASE appropriateness criteria for transesophageal echocardiography in an academic medical center.J Am Soc Echocardiogr. 2009; 22: 517-522
John D Mitchell FM, Albert T Cheung. Intraoperative rescue transesophageal echocardiography (TEE). In: Mark JB, ed. UpToDate 2021. Accessed July 17, 2021, from https://www.uptodate.com/contents/Intraoperative-transesophageal-echocardiography-for-noncardiac-surgery
- Comparative effectiveness and harms of intraoperative transesophageal echocardiography in noncardiac surgery: A systematic review.Semin Cardiothorac Vasc Anesth. 2018; 22: 122-136
- Echocardiography-based hemodynamic management of left ventricular diastolic dysfunction: a feasibility and safety study.Echocardiography. 2014; 31: 1189-1198
- Feasibility of focused cardiac ultrasound during cardiac arrest in the emergency department.Cardiovasc Ultrasound. 2021; 19: 19
- Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.Resuscitation. 2016; 109: 33-39
- Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram.Acad Emerg Med. 2001; 8: 616-621
- 2022 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.([e-pub ahead of print])Circulation. 2022https://doi.org/10.1161/CIR.0000000000001095 (Accessed Auguest 17, 2022)
- Implementation of the Cardiac Arrest Sonographic Assessment (CASA) protocol for patients with cardiac arrest is associated with shorter CPR pulse checks.Resuscitation. 2018; 131: 69-73
- Echocardiographic pre-pause imaging and identifying the acoustic window during CPR reduces CPR pause time during ACLS - A prospective Cohort Study.Resusc Plus. 2021; 6100094
- The diagnosis of thoracic aortic dissection by noninvasive imaging procedures.N Engl J Med. 1993; 328: 1-9
- Association between left ventricular outflow tract opening and successful resuscitation after cardiac arrest.Resuscitation. 2019; 138: 8-14
- Transesophageal echocardiography during cardiopulmonary resuscitation is associated with shorter compression pauses compared with transthoracic echocardiography.Ann Emerg Med. 2019; 73: 610-616
- Evidence for the 'cardiac pump theory' in cardiopulmonary resuscitation in man by transesophageal echocardiography.Resuscitation. 1991; 22: 275-282
- A novel anatomic landmark to target the left ventricle during chest compressions in cardiac arrest.Cureus. 2021; 13: e13652
- Radiological assessment of chest compression point and achievable compression depth in cardiac patients.Scand J Trauma Resusc Emerg Med. 2016; 24: 54
- Compression of the left ventricular outflow tract during cardiopulmonary resuscitation.Acad Emerg Med. 2009; 16: 928-933
- Cardiac movement identified on prehospital echocardiography predicts outcome in cardiac arrest patients.Prehosp Emerg Care. 2012; 16: 251-255
- Prehospital echocardiography during resuscitation impacts treatment in a physician-staffed helicopter emergency medical service: An observational study.Prehosp Emerg Care. 2018; 22: 406-413
- Out-of-hospital transesophageal echocardiogram for cardiac arrest resuscitation: The initial case.Prehosp Emerg Care. 2020; 24: 90-93
- Temporary transvenous pacer placement under transesophageal echocardiogram guidance in the emergency department.Am J Emerg Med. 2020; 38 (e3-4): 1044
- Transesophageal echocardiography guidance for atrial-caval thrombus removal with the AngioVac system.Proc (Bayl Univ Med Cent). 2020; 33: 85-86
- Echocardiography for adult patients supported with extracorporeal membrane oxygenation.Crit Care. 2015; 19: 326
- Transesophageal lung ultrasonography: A novel technique for investigating hypoxemia.Can J Anaesth. 2016; 63: 1266-1276
- Transesophageal echocardiography for diagnosis of traumatic aortic injury: An appraisal of the evidence.J Trauma. 2004; 57: 1246-1255
- Echocardiography and management for cardiac trauma.J Cardiothorac Vasc Anesth. 2022; 36: 3265-3277
- Practice patterns of transesophageal echocardiography use among trauma patients: A multi-institutional retrospective study.Am Surg. 2022; ([e-pub ahead of print]) (Accessed September 21, 2022)https://doi.org/10.1177/00031348221084087
- Intraoperative pulmonary embolism diagnosed by rescue transesophageal echocardiography in a morbidly obese patient undergoing orthopedic surgery following motor vehicle crash.Case Rep Anesthesiol. 2019; 20192429194
- Intraoperative rescue transesophageal echocardiography in a prone patient.J Cardiothorac Vasc Anesth. 2019; 33: 877-878
- Transesophageal echocardiography in prone position during severe acute respiratory distress syndrome.Intensive Care Med. 2011; 37: 430-434
- Transthoracic echocardiography in prone patients with acute respiratory distress syndrome: A feasibility study.Crit Care Explor. 2020; 2: e0179
- Transesophageal echocardiography remains essential and safe during prone ventilation for hemodynamic monitoring of patients with COVID-19.J Am Soc Echocardiogr. 2020; 33: 1057-1059
- Hemodynamic response to prone ventilation in COVID-19 patients assessed with 3D transesophageal echocardiography.Intensive Care Med. 2020; 46: 2099-2101
- Complications of transesophageal echocardiography: A review of injuries, risk factors and management.J Cardiothorac Vasc Anesth. 2022; 36: 3292-3302
- Transoesophageal echocardiography (TOE): Contra-indications, complications and safety of perioperative TOE.Echo Res Pract. 2018; 5: R101-R113
- Safety of transesophageal echocardiography.J Am Soc Echocardiogr. 2010; 23 (quiz 220-1): 1115-1127
- Safety of transesophageal echocardiography to guide structural cardiac interventions.J Am Coll Cardiol. 2020; 75: 3164-3173
- Safety of transesophageal echocardiography performed by intensivists and emergency physicians in critically ill patients with coagulopathy and thrombocytopenia: A single-center experience.J Intensive Care Med. 2021; 36: 123-130
- ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians.J Am Soc Echocardiogr. 2011; 24: 229-267
American Society of Anesthesiologists. Statement on transesophageal echocardiography. Available at: https://www.asahq.org/standards-and-guidelines/statement-on-transesophageal-echocardiography. Accessed July 10, 2022.
- ASE/SCA recommendations and guidelines for continuous quality improvement in perioperative echocardiography.Anesth Analg. 2006; 103: 1416-1425
- Artificial intelligence in echocardiography for anesthesiologists.J Cardiothorac Vasc Anesth. 2021; 35: 251-261
- Artificial intelligence application on point-of-care ultrasound.J Cardiothorac Vasc Anesth. 2021; 35: 3451-3452
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Published online: January 02, 2023
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