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Zarama V, Arango-Granados MC, Manzano-Nunez R, Sheppard JP, Roberts N, Plüddemann A. The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2024; 32:19. [PMID: 38468316 PMCID: PMC10926567 DOI: 10.1186/s13049-024-01192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Chest pain is responsible for millions of visits to the emergency department (ED) annually. Cardiac ultrasound can detect ischemic changes, but varying accuracy estimates have been reported in previous studies. We synthetized the available evidence to yield more precise estimates of the accuracy of cardiac ultrasound for acute myocardial ischemia in patients with chest pain in the ED and to assess the effect of different clinical characteristics on test accuracy. METHODS A systematic search for studies assessing the diagnostic accuracy of cardiac ultrasound for myocardial ischemia in the ED was conducted in MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Web of Science, two trial registries and supplementary methods, from inception to December 6th, 2022. Prospective cohort, cross-sectional, case-control studies and randomized controlled trials (RCTs) that included data on diagnostic accuracy were included. Risk of bias was assessed with the QUADAS-2 tool and a bivariate hierarchical model was used for meta-analysis with paired Forest and SROC plots used to present the results. Subgroup analyses was conducted on clinically relevant factors. RESULTS Twenty-nine studies were included, with 5043 patients. The overall summary sensitivity was 79.3% (95%CI 69.0-86.8%) and specificity was 87.3% (95%CI 79.9-92.2%), with substantial heterogeneity. Subgroup analyses showed increased sensitivity in studies where ultrasound was conducted at ED admission and increased specificity in studies that excluded patients with previous heart disease, when the target condition was acute coronary syndrome, or when final chart review was used as the reference standard. There was very low certainty in the results based on serious risk of bias and indirectness in most studies. CONCLUSIONS Cardiac ultrasound may have a potential role in the diagnostic pathway of myocardial ischemia in the ED; however, a pooled accuracy must be interpreted cautiously given substantial heterogeneity and that important patient and test characteristics affect its diagnostic performance. PROTOCOL REGISTRATION PROSPERO (CRD42023392058).
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Affiliation(s)
- Virginia Zarama
- Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Colombia.
- Department of Emergency Medicine, Fundación Valle del Lili, Carrera 98 # 18-49, 760032, Cali, Colombia.
- Nuffield Department of Primary Care Health Sciences and the Department for Continuing Education, University of Oxford, Oxford, Oxfordshire, UK.
| | - María Camila Arango-Granados
- Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Colombia
- Department of Emergency Medicine, Fundación Valle del Lili, Carrera 98 # 18-49, 760032, Cali, Colombia
| | | | - James P Sheppard
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxfordshire, UK
| | - Annette Plüddemann
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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Ebadi-Tehrani M, Sheu R, Alfirevic A, Kazanjian P, Zimmerman K, Mathis M, Swaminathan M, Mackensen GB, Nicoara A. Practical Considerations for Obtaining Perioperative Transesophageal Echocardiography Accreditation: Collective Experiences at Early-Adopting Centers. J Cardiothorac Vasc Anesth 2024; 38:616-625. [PMID: 38087669 DOI: 10.1053/j.jvca.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 02/18/2024]
Abstract
The Intersocietal Accreditation Commission (IAC) is a nonprofit accrediting organization committed to ensuring the quality of diagnostic imaging and related procedures. It comprises a collaboration of stakeholders spanning numerous medical professionals and specialties. In a recent initiative, IAC Echocardiography introduced a new accreditation specifically for Perioperative Transesophageal Echocardiography (PTE). This accreditation process is anchored in rigorous clinical peer review to ensure diagnostic quality and report accuracy, thus maintaining high standards of medical care. The authors present the inaugural 4 sites to achieve IAC accreditation for PTE, which have collaborated to share their experiences in achieving this accreditation. This review endeavors to offer actionable insights and proven solutions to navigate the accreditation journey for others. Mirroring the IAC Standards and Guidelines for PTE accreditation, this review is divided into three pivotal sections as follows: (1) organization of a perioperative echocardiography service, including stakeholder engagement to facilitate the application for accreditation; (2) performance of examinations and reporting; and (3) instituting quality improvement strategies and establishing a robust program. The pursuit of accreditation in PTE is to transcend a mere compliance exercise. It signifies a dedication to excellence, continual growth, and, above all, to the well-being of patients.
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Affiliation(s)
- Mehran Ebadi-Tehrani
- Department of Anesthesiology and Pain Medicine, University of Michigan Medical School, Ann Arbor, MI.
| | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Paul Kazanjian
- Department of Anesthesiology and Pain Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Karen Zimmerman
- Department of Anesthesiology and Pain Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Michael Mathis
- Department of Anesthesiology and Pain Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
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3
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Arcas-Bellas JJ, Siljeström R, Sánchez C, González A, García-Fernández J. Use of Transesophageal Echocardiography During Orthotopic Liver Transplantation: Simplifying the Procedure. Transplant Direct 2024; 10:e1564. [PMID: 38274476 PMCID: PMC10810591 DOI: 10.1097/txd.0000000000001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 01/27/2024] Open
Abstract
The intraoperative management of patients undergoing orthotopic liver transplantation (OLT) is influenced by the cardiovascular manifestations typically found in the context of end-stage liver disease, by the presence of concomitant cardiovascular disease, and by the significant hemodynamic changes that occur during surgery. Hypotension and intraoperative blood pressure fluctuations during OLT are associated with liver graft dysfunction, acute kidney failure, and increased risk of 30-d mortality. Patients also frequently present hemodynamic instability due to various causes, including cardiac arrest. Recent evidence has shown transesophageal echocardiography (TEE) to be a useful minimally invasive monitoring tool in patients undergoing OLT that gives valuable real-time information on biventricular function and volume status and can help to detect OLT-specific complications or situations. TEE also facilitates rapid diagnosis of life-threatening conditions in each stage of OLT, which is difficult to identify with other types of monitoring commonly used. Although there is no consensus on the best approach to intraoperative monitoring in these patients, intraoperative TEE is safe and useful and should be recommended during OLT, according to experts, for assessing hemodynamic changes, identifying possible complications, and guiding treatment with fluids and inotropes to achieve optimal patient care.
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Affiliation(s)
- José J. Arcas-Bellas
- Department of Anesthesia and Critical Care, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
| | - Roberto Siljeström
- Department of Anesthesia and Critical Care, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
| | - Cristina Sánchez
- Department of Anesthesia and Critical Care, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
| | - Ana González
- Department of Anesthesia and Critical Care, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
| | - Javier García-Fernández
- Department of Anesthesia and Critical Care, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
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4
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Galbas MC, Meissner F, Asmussen A, Straky HC, Schimmel M, Reuter J, Grundmann S, Czerny M, Bothe W. A systematic methodology for epicardial and epiaortic echocardiography in swine research models. Health Sci Rep 2024; 7:e1777. [PMID: 38186934 PMCID: PMC10767764 DOI: 10.1002/hsr2.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background Perioperative echocardiography is of paramount importance during cardiac surgery. Nonetheless, in the experimental large-animal setting, it might be challenging obtaining optimal imaging when using conventional imaging acquisition techniques, such as transthoracic and transesophageal screenings. Open-chest surgery allows epicardial echocardiographic assessment with direct contact between probe and heart, thus providing superior quality. Standard protocols regarding the use of epicardial ultrasound in swine for research purposes are lacking. Methods Epicardial echocardiography was performed in 10 female German Landrace pigs undergoing cardiac surgery. A structured and comprehensive protocol for epicardial echocardiography was elaborated including apical, ventricular long and short axis, as well as epiaortic planes. All experiments were approved by the local board for animal welfare and conducted in accordance with the German animal protection law (TierSchG) and the ARRIVE guidelines. Conclusions Systematic protocols using epicardial echocardiography may serve as an additional tool to assess cardiac dimensions and function in experimental scenarios with swine models.
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Affiliation(s)
- Michelle C. Galbas
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Florian Meissner
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Alexander Asmussen
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Hendrik C. Straky
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Marius Schimmel
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Johanna Reuter
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Sebastian Grundmann
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, Heart Center Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
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Fischer MA, Williams TM, Harvey R, Neelankavil J. Making a Statement: The Need for a Formal Training Statement in Cardiac Anesthesiology. J Cardiothorac Vasc Anesth 2023; 37:1847-1849. [PMID: 37385881 DOI: 10.1053/j.jvca.2023.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Matthew A Fischer
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tiffany M Williams
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Reed Harvey
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jacques Neelankavil
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Maus T, Cronin B, Khoche S. Intersocietal Accreditation Commission Standards and Guidelines for Perioperative Transesophageal Echocardiography Accreditation: The Anticipated Next Step. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00238-0. [PMID: 37147209 DOI: 10.1053/j.jvca.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Timothy Maus
- Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California.
| | - Brett Cronin
- Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | - Swapnil Khoche
- Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
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7
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M, Arrighi JA, Mendes LA, Adams JE, Brush JE, Dec GW, Denktas A, Fernandes S, Freeman R, Hahn RT, Halperin JL, Housholder-Hughes SD, Khan SS, Klarich KW, Lin CH, Marine JE, McPherson JA, Niazi K, Ryan T, Solomon MA, Spicer RL, Tam M, Wang A, Weissman G, Weitz HH, Williams ES. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. J Am Soc Echocardiogr 2020; 32:919-943. [PMID: 31378259 DOI: 10.1016/j.echo.2019.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Nowosielecka D, Polewczyk A, Jacheć W, Tułecki Ł, Tomków K, Stefańczyk P, Kleinrok A, Kutarski A. A new approach to the continuous monitoring of transvenous lead extraction using transesophageal echocardiography—Analysis of 936 procedures. Echocardiography 2020; 37:601-611. [DOI: 10.1111/echo.14628] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 12/12/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dorota Nowosielecka
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Anna Polewczyk
- Collegium Medicum The Jan Kochanowski University Kielce Poland
- Department of Cardiac Surgery Swietokrzyskie Cardiology Center Kielce Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology Silesian Medical University Zabrze Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Konrad Tomków
- Department of Cardiac Surgery The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Paweł Stefańczyk
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
| | - Andrzej Kleinrok
- Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Zamosc Poland
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9
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz‐Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin M, Rose GA, Swaminathan M. 2019 ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA clinical competence statement on echocardiography). Catheter Cardiovasc Interv 2019; 94:481-505. [DOI: 10.1002/ccd.28313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography). J Am Coll Cardiol 2019; 74:377-402. [DOI: 10.1016/j.jacc.2019.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. Circ Cardiovasc Imaging 2019. [DOI: 10.1161/hci.0000000000000026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wang S, Wei J, Yuan S, He Y, Han J, Lu J, Cheng W, Huang J. Intraoperative Transesophageal Echocardiography During Cardiovascular Surgery in China. J Cardiothorac Vasc Anesth 2019; 33:1343-1350. [PMID: 30467029 DOI: 10.1053/j.jvca.2018.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To perform a comprehensive nationwide survey of more than 90% of all cardiovascular hospitals in China to assess the current 2018 status of transesophageal echocardiography (TEE) equipment, operating physicians, education, impact on surgery, and reimbursement. DESIGN In this nationwide survey, 716 cardiovascular hospitals in mainland China were included. A 15-question electronic survey was sent to these hospitals and the data were received directly from the questionnaire website for analysis. SETTING Cardiovascular hospitals in mainland China. PARTICIPANTS Departments of anesthesiology in cardiovascular hospitals in mainland China. INTERVENTIONS Answer a 15-question survey. MEASUREMENTS AND MAIN RESULTS About 90% of hospitals have acquired machines to perform TEEs with most of the machines controlled by the ultrasound department. Anesthesiologists performed intraoperative TEEs in 45% of the hospitals, but only 15% of the hospitals have anesthesiologists who have met the basic TEE training requirements. Most anesthesiologists (68%) believed TEE significantly contributed to patient care during cardiovascular surgeries. The overwhelming majority of surveyed hospital staff (93%) stated that they were planning to continue or start intraoperative TEE examinations in the future. CONCLUSION Many hospitals in China have acquired equipment to perform intraoperative TEE examinations during cardiovascular surgeries. However, the number of anesthesiologists who can perform TEEs independently still is not adequate. Standardized trainings, a formal certification process, and governmental payment model changes must be provided to ensure high-quality TEE services and better surgical outcomes in China.
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Affiliation(s)
- Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China; Shantou University Medical College, Shantou, Guangdong Province, China
| | - Su Yuan
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi He
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Jiange Han
- Department of Anesthesiology, Tianjin Chest Hospital, Tianjin, China
| | - Jiakai Lu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Weiping Cheng
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jiapeng Huang
- Department of Anesthesiology, Jewish Hospital and Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY.
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Zimmerman J. A Recipe for Success in Echocardiography Training: The University of Utah Experience. J Cardiothorac Vasc Anesth 2018; 32:2607-2613. [DOI: 10.1053/j.jvca.2017.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Indexed: 11/11/2022]
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Patel SG, Saroli TL, Horowitz R. Point-of-Care Cardiac Ultrasound (POCCUS) in the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Kovell LC, Ali MT, Hays AG, Metkus TS, Madrazo JA, Corretti MC, Mayer SA, Abraham TP, Shapiro EP, Mukherjee M. Defining the Role of Point-of-Care Ultrasound in Cardiovascular Disease. Am J Cardiol 2018; 122:1443-1450. [PMID: 30115421 DOI: 10.1016/j.amjcard.2018.06.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 12/15/2022]
Abstract
Echocardiography is the foundation for diagnostic cardiac testing, allowing for direct identification and management of various conditions. Point-of-care ultrasound (POCUS) has emerged as an invaluable tool for bedside diagnosis and management. The objective of this review is to address the current use and clinical applicability of POCUS to identify, triage, and manage a wide spectrum of cardiac conditions. POCUS can change diagnosis and management decisions of various cardiovascular conditions in a range of settings. In the outpatient setting, it is used to risk stratify and diagnose a variety of medical conditions. In the emergency department (ED) and critical care settings, it is used to guide triage and critical care interventions. Furthermore, the skills needed to perform POCUS can be taught to noncardiologists in a way that is retained and allows identification of normal and grossly abnormal cardiac findings. Various curricula have been developed that teach residents and advanced learners how to appropriately employ point-of-care ultrasound. In conclusion, POCUS can be a useful adjunct to the physical exam, particularly in critical care applications.
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Saranteas T, Igoumenou VG, Megaloikonomos PD, Mavrogenis AF. Ultrasonography in Trauma: Physics, Practice, and Training. JBJS Rev 2018; 6:e12. [PMID: 29688910 DOI: 10.2106/jbjs.rvw.17.00132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Theodosios Saranteas
- Second Department of Anesthesiology (T.S.) and First Department of Orthopaedics (V.G.I., P.D.M., and A.F.M.), National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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17
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Fayad A, Shillcutt S, Meineri M, Ruddy TD, Ansari MT. Comparative Effectiveness and Harms of Intraoperative Transesophageal Echocardiography in Noncardiac Surgery: A Systematic Review. Semin Cardiothorac Vasc Anesth 2018; 22:122-136. [DOI: 10.1177/1089253218756756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraoperative use of transesophageal echocardiography (TEE) has become commonplace in high-risk noncardiac surgeries but the balance of benefits and harms remains unclear. This systematic review investigated the comparative effectiveness and harms of intraoperative TEE in noncardiac surgery. We searched Ovid MEDLINE, PubMed, EMBASE, and the Cochrane Library from 1946 to March 2017. Two reviewers independently screened the literature for eligibility. Studies were assessed for the risk of selection bias, confounding, measurement bias, and reporting bias. Three comparative and 13 noncomparative studies were included. Intraoperative TEE was employed in a total of 1912 of 3837 patients. Studies had important design limitations. Data were not amenable to quantitative synthesis due to clinical and methodological diversity. Reported incidence of TEE complications ranged from 0% to 1.7% in patients undergoing various procedures (5 studies, 540 patients). No serious adverse events were observed for mixed surgeries (2 studies, 197 patients). Changes in surgical or medical management attributable to the use of TEE were noted in 17% to 81% of patients (7 studies, 558 patients). The only randomized trial of intraoperative TEE was grossly underpowered to detect meaningful differences in 30-day postoperative outcomes. There is lack of high-quality evidence of effectiveness and harms of intraoperative TEE in the management of non-cardiac surgeries. Evidence, however, indicates timely evaluation of cardiac function and structure, and hemodynamics. Future studies should be comparative evaluating confounder-adjusted impact on both intraoperative and 30-day postoperative clinical outcomes.
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Salgado-Filho MF, Morhy SS, Vasconcelos HDD, Lineburger EB, Papa FDV, Botelho ESL, Fernandes MR, Daher M, Bihan DL, Gatto CST, Fischer CH, Silva AAD, Galhardo Júnior C, Neves CB, Fernandes A, Vieira MLC. [Consensus on Perioperative Transesophageal Echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2018; 68:1-32. [PMID: 28867150 PMCID: PMC9391779 DOI: 10.1016/j.bjan.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 01/22/2023]
Abstract
Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.
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Affiliation(s)
- Marcello Fonseca Salgado-Filho
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil.
| | - Samira Saady Morhy
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Henrique Doria de Vasconcelos
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Universidade Federal do Vale da São Francisco (Univasf), Petrolina, PE, Brasil; Jonhs Hopkins University, Baltimore, EUA
| | - Eric Benedet Lineburger
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Hospital São José, Criciúma, SC, Brasil
| | - Fabio de Vasconcelos Papa
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Takaoka Anestesia, São Paulo, SP, Brasil
| | - Eduardo Souza Leal Botelho
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil; Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
| | - Marcelo Ramalho Fernandes
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil; Hospital Copa Star, Rio de Janeiro, RJ, Brasil
| | - Maurício Daher
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brasil
| | - David Le Bihan
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil; Hospital do Rim e Hipertensão, São Paulo, SP, Brasil; Grupo Dasa, São Paulo, SP, Brasil
| | - Chiara Scaglioni Tessmer Gatto
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto do Coração (Incor), São Paulo, SP, Brasil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Cláudio Henrique Fischer
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alexander Alves da Silva
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; São Paulo Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brasil
| | - Carlos Galhardo Júnior
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil
| | - Carolina Baeta Neves
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil; Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alexandre Fernandes
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil; Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
| | - Marcelo Luiz Campos Vieira
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; Instituto do Coração (Incor), São Paulo, SP, Brasil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
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Salgado-Filho MF, Morhy SS, Vasconcelos HDD, Lineburger EB, Papa FDV, Botelho ESL, Fernandes MR, Daher M, Bihan DL, Gatto CST, Fischer CH, Silva AAD, Galhardo Júnior C, Neves CB, Fernandes A, Vieira MLC. Consensus on Perioperative Transesophageal Echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 28867150 PMCID: PMC9391779 DOI: 10.1016/j.bjane.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), created a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.
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20
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Surgery Versus Transcatheter Interventions for Significant Paravalvular Prosthetic Leaks. JACC Cardiovasc Interv 2017; 10:1959-1969. [DOI: 10.1016/j.jcin.2017.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 11/21/2022]
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21
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Pahl C, Ebelt H, Sayahkarajy M, Supriyanto E, Soesanto A. Towards Robot-Assisted Echocardiographic Monitoring in Catheterization Laboratories : Usability-Centered Manipulator for Transesophageal Echocardiography. J Med Syst 2017; 41:148. [PMID: 28812247 DOI: 10.1007/s10916-017-0786-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
This paper proposes a robotic Transesophageal Echocardiography (TOE) system concept for Catheterization Laboratories. Cardiovascular disease causes one third of all global mortality. TOE is utilized to assess cardiovascular structures and monitor cardiac function during diagnostic procedures and catheter-based structural interventions. However, the operation of TOE underlies various conditions that may cause a negative impact on performance, the health of the cardiac sonographer and patient safety. These factors have been conflated and evince the potential of robot-assisted TOE. Hence, a careful integration of clinical experience and Systems Engineering methods was used to develop a concept and physical model for TOE manipulation. The motion of different actuators of the fabricated motorized system has been tested. It is concluded that the developed medical system, counteracting conflated disadvantages, represents a progressive approach for cardiac healthcare.
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Affiliation(s)
- Christina Pahl
- Biomechatronics Group, Faculty of Mechanical Engineering, Technische Universitaet Ilmenau, 98693, Ilmenau, Germany. .,Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia.
| | - Henning Ebelt
- Klinik für Innere Medizin II/ Kardiologie und Internistische Intensivmedizin Katholisches Krankenhaus, "St. Johann Nepomuk", Haarbergstrasse 72, 99097, Erfurt, Germany
| | - Mostafa Sayahkarajy
- Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia
| | - Eko Supriyanto
- Advanced Diagnostics and Progressive Human Care Research Group, IJN-UTM Cardiovascular Engineering Centre, Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia
| | - Amiliana Soesanto
- Department Cardiology & Vascular Medicine, Faculty of Medicine Universitas Indonesia/ National Cardiovascular Center "Harapan Kita", 11420, Jakarta, Indonesia
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Abstract
Holistic ultrasound is a total body examination using an ultrasound device aiming to achieve immediate patient care and decision making. In the setting of trauma, it is one of the most fundamental components of care of the injured patients. Ground-breaking imaging software allows physicians to examine various organs thoroughly, recognize imaging signs early, and potentially foresee the onset or the possible outcome of certain types of injuries. Holistic ultrasound can be performed on a routine basis at the bedside of the patients, at admission and during the perioperative period. Trauma care physicians should be aware of the diagnostic and guidance benefits of ultrasound and should receive appropriate training for the optimal management of their patients. In this paper, the findings of holistic ultrasound in trauma patients are presented, with emphasis on the lungs, heart, cerebral circulation, abdomen, and airway. Additionally, the benefits of ultrasound imaging in interventional anaesthesia techniques such as ultrasound-guided peripheral nerve blocks and central vein catheterization are described.
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Affiliation(s)
- Theodosios Saranteas
- Department of Anaesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece.
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Marin JR, Lewiss RE. Point-of-care ultrasonography by pediatric emergency physicians. Policy statement. Ann Emerg Med 2016; 65:472-8. [PMID: 25805037 DOI: 10.1016/j.annemergmed.2015.01.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Indexed: 01/10/2023]
Abstract
Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. Pediatric emergency medicine fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for pediatric emergency physicians.
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Ryan T, Berlacher K, Lindner JR, Mankad SV, Rose GA, Wang A. COCATS 4 Task Force 5: Training in Echocardiography: Endorsed by the American Society of Echocardiography. J Am Soc Echocardiogr 2016; 28:615-27. [PMID: 26041570 DOI: 10.1016/j.echo.2015.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Stainback RF, Estep JD, Agler DA, Birks EJ, Bremer M, Hung J, Kirkpatrick JN, Rogers JG, Shah NR. Echocardiography in the Management of Patients with Left Ventricular Assist Devices: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2015; 28:853-909. [DOI: 10.1016/j.echo.2015.05.008] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ryan T, Berlacher K, Lindner JR, Mankad SV, Rose GA, Wang A. COCATS 4 Task Force 5: Training in Echocardiography. J Am Coll Cardiol 2015; 65:1786-99. [DOI: 10.1016/j.jacc.2015.03.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Markin NW, Sharma A, Grant W, Shillcutt SK. The safety of transesophageal echocardiography in patients undergoing orthotopic liver transplantation. J Cardiothorac Vasc Anesth 2015; 29:588-93. [PMID: 25622974 DOI: 10.1053/j.jvca.2014.10.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the safety of transesophageal echocardiography for the evaluation and intraoperative monitoring of patients during orthotopic liver transplantation. DESIGN Retrospective observational study. SETTING Tertiary care, university teaching hospital. PARTICIPANTS Patients (n = 116) who underwent intraoperative transesophageal echocardiography during liver transplantation. INTERVENTIONS Intraoperative transesophageal echocardiography during liver transplantation. MEASUREMENTS AND MAIN RESULTS The authors evaluated the safety of intraoperative transesophageal echocardiography in patients undergoing liver transplantation through a retrospective chart review. Complications associated with transesophageal echocardiography use were divided into minor and major complications. Out of 116 patients who underwent intraoperative transesophageal echocardiography, there was one minor and one major complication. The major complication rate was 0.86% (1/116) and the overall complication rate was 1.7% (2/116). There was no statistically significant correlation between pre-transplant sclerotherapy for treatment of varices and intraoperative transesophageal echocardiography-related gastrointestinal bleeding. Although the reported complication rate is higher than what has been quoted in the cardiac literature, intraoperative transesophageal echocardiography during liver transplantation has a low complication rate. CONCLUSIONS Intraoperative transesophageal echocardiography is a relatively safe method of monitoring cardiac performance in liver transplant patients.
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Affiliation(s)
| | | | - Wendy Grant
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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Peng YG, Song H, Wang E, Wang W, Liu J. Essential training steps to achieving competency in the basic intraoperative transesophageal echocardiography examination for Chinese anesthesiologists. Front Med 2014; 9:123-8. [PMID: 25337689 DOI: 10.1007/s11684-014-0366-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
Abstract
Guidelines for the intraoperative transesophageal echocardiography (TEE) examination have defined a detailed standard for medical professionals, particularly anesthesiologists, on how a TEE exam should proceed. Over the years, TEE has gained substantial popularity and emerged as a preferred monitoring modality to aid in perioperative management and decision making during hemodynamic instability situations or critical care settings. TEE training pathways and practice guidelines have been well established in western countries and many regions of the world. However, TEE training and practice information for anesthesiologists are lacking in China. As innovative technologies develop, other educational models have emerged to aid in obtaining competency in basic TEE exam. Hence, establishing a consensus on the ideal TEE training approach for anesthesiologists in China is urgently needed. Developing an effective curriculum that can be incorporated into an anesthesiology resident's overall training is also necessary to provide knowledge and skills toward competency in basic TEE exam. With evolving medical system reforms and increasing demands for intraoperative hemodynamic monitoring to accommodate surgical innovations, anesthesiology professionals are increasingly obliged to perform intraoperative TEE exams in their current and future practices. To overcome obstacles and achieve significant progress in using the TEE modality to help in intraoperative management and surgical decision making, publishing basic TEE training guidelines for China's anesthesiologists is an important endeavor.
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Affiliation(s)
- Yong G Peng
- Department of Anesthesiology, College of Medicine, University of Florida Shands Hospital, Gainesville, FL, 32610, USA,
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Geisen M, Spray D, Nicholas Fletcher S. Echocardiography-Based Hemodynamic Management in the Cardiac Surgical Intensive Care Unit. J Cardiothorac Vasc Anesth 2014; 28:733-44. [DOI: 10.1053/j.jvca.2013.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Indexed: 11/11/2022]
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Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination. Anesth Analg 2014; 118:21-68. [DOI: 10.1213/ane.0000000000000016] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, Picard MH. 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; 26:921-64. [PMID: 23998692 DOI: 10.1016/j.echo.2013.07.009] [Citation(s) in RCA: 743] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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32
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Liang P, Chen YJ, Liu B. Case scenario about TEE: Patient with dilated cardiomyopathy undergoing laparoscopic cholecystectomy. Pak J Med Sci 2013; 29:675-7. [PMID: 24353604 PMCID: PMC3809262 DOI: 10.12669/pjms.292.3077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/29/2013] [Accepted: 03/28/2013] [Indexed: 02/05/2023] Open
Abstract
A 42-year-old woman, who presented with DCM (American Society of Anesthesia, ASA class IV), suffered from gallstone for years, and was scheduled for laparoscopic cholecystectomy. Echocardiography demonstrated a severely dilated left ventricle with global hypokinesia and reduction of left ventricular systolic function, ejection fraction (EF) 34% with mild mitral regurgitation and severe tricuspid regurgitation. After intubation, a transesophageal echocardiography (TEE) probe was inserted. When the IAP was gradually ascended to 14 mmHg during the laparoscopy, EF fell to 19% and the systolic pressure fell to 78 mmHg and TEE showed severely poor wall motion. But the central venous pressure (CVP) still showed about 4 mmHg throughout the whole procedure. After decreasing the IAP to 10 mmHg, we adjusted the rate of pacemaker to 70 times per minute then the systolic pressure was kept at around 100 mmHg, and the diastolic pressure was kept at 60 mmHg. EF was 30% after the reduction of IAP and the adjusting of the heart rate set. TEE is a helpful monitor in anesthesia management of patients with DCM during noncardiac surgery and CVP is useless especially for the procedure with severe hemodynamic effects.
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Affiliation(s)
- Peng Liang
- Peng Liang, MD, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China 610041
| | - Yuan-Jing Chen
- Yuan-jing Chen, MD, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China 610041
| | - Bin Liu
- Bin Liu, MD, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China 610041
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Hien MD, Großgasteiger M, Rauch H, Weymann A, Bekeredjian R, Rosendal C. Experts and Beginners Benefit from Three-Dimensional Echocardiography: A Multicenter Study on the Assessment of Mitral Valve Prolapse. J Am Soc Echocardiogr 2013; 26:828-34. [DOI: 10.1016/j.echo.2013.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Indexed: 10/26/2022]
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Reeves ST, Finley AC, Skubas NJ, Swaminathan M, Whitley WS, Glas KE, Hahn RT, Shanewise JS, Adams MS, Shernan SK. 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; 26:443-56. [DOI: 10.1016/j.echo.2013.02.015] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sniecinski RM. Perioperative echocardiography…evolving back to basics. J Am Soc Echocardiogr 2012; 26:A21-2. [PMID: 23261372 DOI: 10.1016/j.echo.2012.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Thorac Cardiovasc Surg 2012; 144:e29-84. [PMID: 22898522 DOI: 10.1016/j.jtcvs.2012.03.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2012; 79:1023-82. [DOI: 10.1002/ccd.24351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2012; 93:1340-95. [PMID: 22300625 DOI: 10.1016/j.athoracsur.2012.01.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 12/20/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, DiSesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2012; 143:4-34. [PMID: 22172748 DOI: 10.1016/j.jtcvs.2011.10.015] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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40
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59:1200-54. [PMID: 22300974 DOI: 10.1016/j.jacc.2012.01.001] [Citation(s) in RCA: 544] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:2610-42. [PMID: 22064600 DOI: 10.1161/cir.0b013e31823b5fee] [Citation(s) in RCA: 337] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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London MJ, Skubas NJ. Echo didactics: a new venue for basic and advanced echo education in Anesthesia & Analgesia. Anesth Analg 2011; 113:10-2. [PMID: 21700693 DOI: 10.1213/ane.0b013e31821c36d4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Ultrasound applications in perioperative medicine have expanded enormously over the past decade. Transoesophageal echocardiography has been performed by anaesthetists during cardiac surgery for over 20 years. With the increasing availability of portable ultrasound systems, the use of ultrasound to assist in vascular cannulation and regional anaesthesia has been well described. Portable ultrasound systems come with a range of probes for different applications, including transthoracic echocardiography. While transthoracic echocardiography has traditionally been the domain of cardiologists, its use has been increasing in critical care, the emergency room and, recently, by anaesthetists in the perioperative period. Unlike formal cardiology-based transthoracic echocardiography, focused, goal-directed transthoracic echocardiography is often more appropriate in the perioperative period to address a particular question and can be performed in just a few minutes. Transthoracic echocardiography allows rapid, noninvasive, point-of-care assessment of ventricular function, valvular integrity, volume status and fluid responsiveness. It can help distinguish undifferentiated systolic murmurs preoperatively, give valuable information on the aetiology of unexplained hypotension and cardiovascular collapse and assess response to therapeutic interventions such as vasoactive drugs and volume resuscitation. Focused transthoracic echocardiography should include qualitative assessment of left and right ventricular function, an estimate of aortic valve gradient, right ventricular systolic pressure and intravascular volume status as minimum requirements. Transthoracic echocardiography is a valuable tool in the perioperative period and ideally the equipment and expertise should be available in all operating rooms.
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Affiliation(s)
- B. S. Cowie
- Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Three-Dimensional Transesophageal Echocardiography Is a Major Advance for Intraoperative Clinical Management of Patients Undergoing Cardiac Surgery. Anesth Analg 2010; 110:1548-73. [DOI: 10.1213/ane.0b013e3181d41be7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Shook DC. Basic perioperative transesophageal echocardiography: an education opportunity and a dilemma. J Am Soc Echocardiogr 2010; 23:34A, 34A.e1. [PMID: 20362922 DOI: 10.1016/j.echo.2010.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pearlman AS, Adams DB, Kraft CD, Witt SA. Advancing Recognition of the Responsibilities of Cardiac Sonographers. J Am Soc Echocardiogr 2009; 22:1414-6. [DOI: 10.1016/j.echo.2009.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Thys DM. Cardiac Anesthesia: Thirty Years Later—The Second Annual Arthur E. Weyman Lecture. Anesth Analg 2009; 109:1782-90. [DOI: 10.1213/ane.0b013e3181be4002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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