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Kistler PM, Sanders P, Amarena JV, Bain CR, Chia KM, Choo WK, Eslick AT, Hall T, Hopper IK, Kotschet E, Lim HS, Ling LH, Mahajan R, Marasco SF, McGuire MA, McLellan AJ, Pathak RK, Phillips KP, Prabhu S, Stiles MK, Su RW, Thomas SP, Toy T, Watts TW, Weerasooriya R, Wilsmore BR, Wilson L, Kalman JM. 2023 Cardiac Society of Australia and New Zealand Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation. Heart Lung Circ 2024:S1443-9506(24)00170-7. [PMID: 38702234 DOI: 10.1016/j.hlc.2023.12.024] [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: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 05/06/2024]
Abstract
Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF. They are also intended to provide guidance to healthcare facilities seeking to establish or maintain catheter ablation for AF.
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Affiliation(s)
- Peter M Kistler
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
| | - Prash Sanders
- University of Adelaide, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Chris R Bain
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Karin M Chia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Wai-Kah Choo
- Gold Coast University Hospital, Gold Coast, Qld, Australia; Royal Darwin Hospital, Darwin, NT, Australia
| | - Adam T Eslick
- University of Sydney, Sydney, NSW, Australia; The Canberra Hospital, Canberra, ACT, Australia
| | | | - Ingrid K Hopper
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Emily Kotschet
- Victorian Heart Hospital, Monash Health, Melbourne, Vic, Australia
| | - Han S Lim
- University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia; Northern Health, Melbourne, Vic, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Rajiv Mahajan
- University of Adelaide, Adelaide, SA, Australia; Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Silvana F Marasco
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | | | - Alex J McLellan
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia; St Vincent's Hospital, Melbourne, Vic, Australia
| | - Rajeev K Pathak
- Australian National University and Canberra Heart Rhythm, Canberra, ACT, Australia
| | - Karen P Phillips
- Brisbane AF Clinic, Greenslopes Private Hospital, Brisbane, Qld, Australia
| | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Raymond W Su
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Stuart P Thomas
- University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia
| | - Tracey Toy
- The Alfred Hospital, Melbourne, Vic, Australia
| | - Troy W Watts
- Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Rukshen Weerasooriya
- Hollywood Private Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | | | | | - Jonathan M Kalman
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia
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2
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Taboada M, Cariñena A, Estany-Gestal A, Iglesias-Álvarez D, Veiras S, Martínez A, Eiras M, De Miguel M, Selas S, Martínez-Monzonis A, Pereira P, Bastos-Fernández M, González-Salvado V, Álvarez-Barrado M, Ferreiroa E, Caruezo V, Costa J, Naveira A, Otero P, Adrio B, Martínez-Cereijo JM, Fernández Á, González-Juanatey JR, Álvarez J, Seoane-Pillado T. Videolaryngoscope versus conventional technique for insertion of a transesophageal echocardiography probe in intubated ICU patients (VIDLARECO trial): A randomized clinical trial. Anaesth Crit Care Pain Med 2024; 43:101346. [PMID: 38278357 DOI: 10.1016/j.accpm.2024.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Transesophageal echocardiogram probe insertion in intubated critically ill patients can be difficult, leading to complications, such as gastric bleeding or lesions in the oropharyngeal mucosa. We hypothesised that the use of a videolaryngoscope would facilitate the first attempt at insertion of the transesophageal echocardiogram probe and would decrease the incidence of complications compared to the conventional insertion technique. METHODS In this clinical trial, patients were randomly assigned the insertion of a transesophageal echocardiogram probe using a videolaryngoscope or conventional technique. The primary outcome was the successful transesophageal echocardiogram probe insertion on the first attempt. The secondary outcomes included total success rate, number of insertion attempts, and incidence of pharyngeal complications. RESULTS A total of 100 intubated critically ill patients were enrolled. The success rate of transesophageal echocardiogram probe insertion on the first attempt was higher in the videolaryngoscope group than in the conventional group (90% vs. 58%; absolute difference, 32%; 95% CI 16%-48%; p < 0.001). The overall success rate was higher in the videolaryngoscope group than in the conventional group (100% vs. 72%; absolute difference, 28%; 95% CI 16%-40%; p < 0.001). The incidence of pharyngeal mucosal injury was smaller in the videolaryngoscope group than in the conventional group (14% vs. 52%; absolute difference, 38%; 95% CI 21%-55%; p < 0.001). CONCLUSIONS Our study showed that in intubated critically ill patients required transesophageal echocardiogram, the use of videolaryngoscope resulted in higher successful insertion on the first attempt with lower rate of complications when compared with the conventional insertion technique. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04980976.
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Affiliation(s)
- Manuel Taboada
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain.
| | - Agustín Cariñena
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Ana Estany-Gestal
- Research Methodology Unit, Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago, Spain
| | | | - Sonia Veiras
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Adrián Martínez
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - María Eiras
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Manuela De Miguel
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Salomé Selas
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | - Pedro Pereira
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | | | | | - Esteban Ferreiroa
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Valentín Caruezo
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Jose Costa
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Alberto Naveira
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Pablo Otero
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Belén Adrio
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Jose Manuel Martínez-Cereijo
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Ángel Fernández
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | | | - Julián Álvarez
- Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago, Sanitary Research Institute of Santiago (IDIS), Spain
| | - Teresa Seoane-Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, A Coruña, Spain
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Grant MC, Crisafi C, Alvarez A, Arora RC, Brindle ME, Chatterjee S, Ender J, Fletcher N, Gregory AJ, Gunaydin S, Jahangiri M, Ljungqvist O, Lobdell KW, Morton V, Reddy VS, Salenger R, Sander M, Zarbock A, Engelman DT. Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS). Ann Thorac Surg 2024; 117:669-689. [PMID: 38284956 DOI: 10.1016/j.athoracsur.2023.12.006] [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: 10/12/2023] [Revised: 11/27/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet of ERAS involves the provision of protocolized evidence-based perioperative interventions. Given both the growing enthusiasm for applying ERAS principles to cardiac surgery and the broad scope of relevant interventions, an international, multidisciplinary expert panel was assembled to derive a list of potential program elements, review the literature, and provide a statement regarding clinical practice for each topic area. This article summarizes those consensus statements and their accompanying evidence. These results provide the foundation for best practice for the management of the adult patient undergoing cardiac surgery.
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Affiliation(s)
- Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Cheryl Crisafi
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Adrian Alvarez
- Department of Anesthesia, Hospital Italiano, Buenos Aires, Argentina
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary E Brindle
- Departments of Surgery and Community Health Services, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joerg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Nick Fletcher
- Institute of Anesthesia and Critical Care, Cleveland Clinic London, London, United Kingdom; St George's University Hospital, London, United Kingdom
| | - Alexander J Gregory
- Department of Anesthesia, Perioperative and Pain Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, London, United Kingdom
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kevin W Lobdell
- Regional Cardiovascular and Thoracic Quality, Education, and Research, Atrium Health, Charlotte, North Carolina
| | - Vicki Morton
- Clinical and Quality Outcomes, Providence Anesthesiology Associates, Charlotte, North Carolina
| | - V Seenu Reddy
- Centennial Heart & Vascular Center, Nashville, Tennessee
| | - Rawn Salenger
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Sander
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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4
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Zeidan A, le Guen M, Bamadhaj M. Navigating critical airways: videolaryngoscopy's role in transesophageal echocardiography probe insertion. Anaesth Crit Care Pain Med 2024; 43:101381. [PMID: 38508393 DOI: 10.1016/j.accpm.2024.101381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Ahed Zeidan
- Department of Anesthesiology, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
| | - Morgan le Guen
- Department of Anesthesiology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Munir Bamadhaj
- Department of Anesthesia and Pain Medicine, Foch Hospital, University of Versailles Saint Quentin, Suresnes, France
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Swerdlow B, Osborne-Smith L, Soelberg J. Design of a Workshop for Focused Transesophageal Echocardiography During Noncardiac Surgery in Nurse Anesthesia Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241229001. [PMID: 38313304 PMCID: PMC10836131 DOI: 10.1177/23821205241229001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE The use of transesophageal echocardiography (TEE) by certified registered nurse anesthetists (CRNAs) during noncardiac surgery is relatively uncommon despite its unique potential to diagnose causes of hemodynamic instability. To address this problem, educational endeavors designed to provide practical TEE skills to CRNAs are needed. The aim of the current study was to evaluate the feasibility, acceptability, efficacy, and utility of a 2-day focused TEE workshop in nurse anesthesia education that employed a protocol involving a limited number of views and used goal-directed, qualitative assessments of critical physiologic parameters. METHODS This was a prospective, observational study involving 14 second-year nurse anesthesia students. The cohort was evaluated following completion of this workshop by simulator-based testing involving hypothetical clinical scenarios, and this test data was analyzed according to the percent successful acquisition and interpretation of TEE views to determine immediate objective teaching efficacy. The acceptability, perceived efficacy, and perceived utility of the workshop were assessed by online survey, and survey responses were qualitative and quantitative in nature. RESULTS Participants acquired appropriate TEE views associated with clinical scenarios 99% of the time and correctly interpreted the pathology in those views 93% of the time. Participants uniformly perceived significant educational value in this workshop and intend to incorporate TEE in their future clinical practice. CONCLUSIONS A 2-day workshop to teach focused TEE to nurse anesthesia trainees directed by a streamlined protocol is feasible, acceptable, and perceived as useful by participants, and provides practical experience and entry-level competency in this point-of-care ultrasound modality.
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Affiliation(s)
- Barry Swerdlow
- Nurse Anesthesia Program, Oregon Health & Science University, Portland, OR, USA
| | - Lisa Osborne-Smith
- Nurse Anesthesia Program, Oregon Health & Science University, Portland, OR, USA
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Julie Soelberg
- Nurse Anesthesia Program, Oregon Health & Science University, Portland, OR, USA
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
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Rubino A, Peck M, Miller A, Edmiston T, Klein AA, Orme R, Sankar V, Fletcher N, O’Keeffe N, Skinner H. Focused transoesophageal TOE (fTOE): A new accreditation pathway. J Intensive Care Soc 2023; 24:419-426. [PMID: 37841296 PMCID: PMC10572472 DOI: 10.1177/17511437231173350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
The concept of a focused ultrasound study to identify sources of haemodynamic instability has revolutionized patient care. Point-of-care ultrasound (POCUS) using transthoracic scanning protocols, such as FUSIC Heart, has empowered non-cardiologists to rapidly identify and treat the major causes of haemodynamic instability. There are, however, circumstances when a transoesphageal, rather than transthoracic approach, may be preferrable. Due to the close anatomical proximity between the oesophagus, stomach and heart, a transoesphageal echocardiogram (TOE) can potentially overcome many of the limitations encountered in patients with poor transthoracic ultrasound windows. These are typically patients with severe obesity, chest wall injuries, inability to lie in the left lateral decubitus position and those receiving high levels of positive airway pressure. In 2022, to provide all acute care practitioners with the opportunity to acquire competency in focused TOE, the Intensive Care Society (ICS) and Association of Anaesthetists (AA) launched a new accreditation pathway, known as Focused Transoesophageal Echo (fTOE). The aim of fTOE is to provide the practitioner with the necessary information to identify the aetiology of haemodynamic instability. Focused TOE can be taught in a shorter period of time than comprehensive and teaching programmes are achievable with support from cardiothoracic anaesthetists, intensivists and cardiologists. Registration for fTOE accreditation requires registration via the ICS website. Learning material include theoretical modules, clinical cases and multiple-choice questions. Fifty fTOE examinations are required for the logbook, and these must cover a range of pathology, including ventricular dysfunction, pericardial effusion, tamponade, pleural effusion and low preload. The final practical assessment may be undertaken when the supervisors deem the candidate's knowledge and skills consistent with that required for independent practice. After the practitioner has been accredited in fTOE, they must maintain knowledge and competence through relevant continuing medical education. Accreditation in fTOE represents a joint venture between the ICS and AA and is endorsed by Association of Cardiothoracic Anaesthesia and Critical care (ACTACC). The process is led by TOE experts, and represents a valuable expansion in the armamentarium of acute care practitioners to assess haemodynamically unstable patients.
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Affiliation(s)
- Antonio Rubino
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Marcus Peck
- Frimley Health NHS Foundation Trust, Frimley, UK
| | - Ashley Miller
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Thomas Edmiston
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Andrew A Klein
- Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Robert Orme
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Vinoth Sankar
- Liverpool University Hospitals NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | | | - Niall O’Keeffe
- Manchester Royal Infirmary, University of Manchester, Manchester, UK
| | - Henry Skinner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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7
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Milojevic M, Milosevic G, Nikolic A, Petrovic M, Petrovic I, Bojic M, Jagodic S. Mastering the Best Practices: A Comprehensive Look at the European Guidelines for Cardiopulmonary Bypass in Adult Cardiac Surgery. J Cardiovasc Dev Dis 2023; 10:296. [PMID: 37504552 PMCID: PMC10380276 DOI: 10.3390/jcdd10070296] [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: 06/03/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.
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Affiliation(s)
- Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- Erasmus University Medical Center, Department of Cardiothoracic Surgery, 3015 GD Rotterdam, The Netherlands
| | - Goran Milosevic
- Department of Perfusion Technology, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Aleksandar Nikolic
- Department of Cardiac Surgery, Acibadem-Sistina Hospital, 1000 Skopje, North Macedonia
| | - Masa Petrovic
- Center of Excellence, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Petrovic
- Center of Excellence, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Milovan Bojic
- Center of Excellence, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Sinisa Jagodic
- Department of Perfusion Technology, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
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8
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Bolton L, Skeoch C, Bhudia SK, Sutt AL. Pharyngeal Dysphagia After Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00318-X. [PMID: 37286397 DOI: 10.1053/j.jvca.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/29/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Lee Bolton
- Speech and Language Therapy, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Christopher Skeoch
- Department of Critical Care and Anaesthesia, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sunil K Bhudia
- Department of Cardiothoracic Surgery, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
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Calim M, Uysal H, Kahraman Ay N, Karaaslan K, Daskaya H. Utility of the gastro-laryngeal tube during transesophageal echocardiography: A prospective randomized clinical trial. Medicine (Baltimore) 2022; 101:e32269. [PMID: 36550887 PMCID: PMC9771168 DOI: 10.1097/md.0000000000032269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To validate the utility and performance of the gastro-laryngeal tube (GLT) in terms of cardiologist and patient satisfaction levels, incidence of and attempts at successful transesophageal echocardiography (TEE) probe placement, perioperative and postoperative hemodynamics, and adverse events related to the TEE procedure. METHODS In this randomized prospective clinical study, forty-four patients undergoing TEE and aged 20 to 80 years old scheduled for TEE were randomly allocated to two study groups: Group SA (sedation and analgesia) and Group GLT. Cardiologist and patient satisfaction levels, TEE probe placement performance, hemodynamics, adverse events related to the TEE procedure, demographic characteristics, and TEE procedure data were recorded. RESULTS The cardiologist satisfaction level was significantly higher in Group GLT (P = .011). The TEE probe was successfully placed at the first attempt in all the patients in Group GLT and at the first attempt in 11 patients, at the second attempt in 8 patients, and at the third attempt in 3 patients in Group SA. The TEE probe placement success was significantly higher in Group GLT (P < .001), and TEE probe placement was significantly easier in Group GLT (P < .001). There were no significant differences in patient satisfaction, heart rate, mean arterial pressure, oxygen saturation, adverse events related to the TEE procedure between the groups. CONCLUSION The present study revealed that GLT use elicited a higher cardiologist satisfaction level and resulted in more successful and easier TEE probe placement. We thus conclude that the use of the recently developed GLT may ensure airway management safety and a comfortable TEE experience.
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Affiliation(s)
- Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
- * Correspondence: Muhittin Calim, Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul 34093, Turkey (e-mail: )
| | - Harun Uysal
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Nuray Kahraman Ay
- Department of Cardiology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Kazim Karaaslan
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Hayrettin Daskaya
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Borde D, C K, Jasapara A, Shetty V, Juvekar N, Desurkar V, Gaidu J, Joshi P, Asegaonkar B, Kp U, V V, Joshi S, Koshy T. Use of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized Study. J Cardiothorac Vasc Anesth 2022; 36:4289-4295. [PMID: 36038439 DOI: 10.1053/j.jvca.2022.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion. DESIGN A multicenter randomized control study. SETTING At 5 tertiary care level hospitals. PARTICIPANTS Three hundred sixty-three adult patients undergoing elective cardiac surgery. INTERVENTIONS The patients were randomized into 2 groups-the conventional group (C group; n = 177) and the VL group (n = 186) for TEE probe insertion. MEASUREMENTS AND MAIN RESULTS The primary endpoint of the study was the incidence of oropharyngeal injury, which was defined as blood at the tip of the TEE probe at the end of surgery and/or evidence of injury on VL examination at the end of surgery. The secondary endpoints of the study were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. There was a higher incidence of injuries in the C group (n = 26; 14.7%) compared to the VL group (n = 14; 7.5%; p = 0.029). The number of attempts for probe insertion was significantly lower in the VL group (p = 0.0023). The most common relation between the esophageal inlet and the larynx was posterolateral (n = 88; 47%), followed by posterior (n = 77; 41%) and lateral (n = 21;12%). CONCLUSION The use of VL was associated with a lesser incidence of injury compared to the conventional technique, and its use for this purpose is recommended. The use of VL for probe insertion resulted in fewer attempts compared with the conventional technique. Significant variations do exist in the relation between the esophageal inlet and the larynx, and direct visualization with VL may contribute to better safety.
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Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Kumar C
- Department of Cardiac Anesthesia, Madras Medical Mission, Chennai, Tamilnadu, India
| | - Amish Jasapara
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
| | - Vijay Shetty
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
| | - Nilesh Juvekar
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Vinayak Desurkar
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Jyoti Gaidu
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Unnikrihnan Kp
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Vipinraj V
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Thomas Koshy
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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11
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Fernandez TMA, Schofield N, Krenn CG, Rizkalla N, Spiro M, Raptis DA, De Wolf AM, Merritt WT. What is the optimal anesthetic monitoring regarding immediate and short-term outcomes after liver transplantation?-A systematic review of the literature and expert panel recommendations. Clin Transplant 2022; 36:e14643. [PMID: 35262975 PMCID: PMC10077907 DOI: 10.1111/ctr.14643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Liver transplant centers vary in approach to intraoperative vascular accesses, monitoring of cardiac function and temperature management. Evidence is limited regarding impact of selected modalities on postoperative outcomes. OBJECTIVES To review the literature and provide expert panel recommendations on optimal intraoperative arterial blood pressure (BP), central venous pressure (CVP), and vascular accesses, monitoring of cardiac function and intraoperative temperature management regarding immediate and short-term outcomes after orthotopic liver transplant (OLT). METHODS Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Recommendations made for: (1) Vascular accesses, arterial BP and CVP monitoring, (2) cardiac function monitoring, and (3) Intraoperative temperature management (CRD42021239908). RESULTS Of 2619 articles screened 16 were included. Studies were small, retrospective, and observational. Vascular access studies demonstrated low rates of insertion complications. TEE studies demonstrated low rates of esophageal hemorrhage. One study found lower hospital-LOS and 30-day mortality in patients monitored with both PAC and TEE. Other monitoring studies were heterogenous in design and outcomes. Temperature studies showed increased blood transfusion and ventilation times in hypothermic groups. CONCLUSIONS Recommendations were made for; routine arterial and CVP monitoring as a minimum standard of practice, consideration of discrepancy between peripheral and central arterial BP in patients with hemodynamic instability and high vasopressor requirements, and routine use of high flow cannulae while monitoring for extravasation and hematoma formation. Availability and expertise in PAC and/or TEE monitoring is strongly recommended particularly in hemodynamic instability, portopulmonary HT and/or cardiac dysfunction. TEE use is recommended as an acceptable risk in patients with treated esophageal varices and is an effective diagnostic tool for emergency cardiovascular collapse. Maintenance of intraoperative normothermia is strongly recommended.
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Affiliation(s)
- Thomas M A Fernandez
- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.,Department of Anesthesia, University of Auckland, Auckland, New Zealand
| | - Nick Schofield
- Department of Anesthesia and Intensive Care Medicine, Royal Free Hospital, London, UK
| | - Claus G Krenn
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicole Rizkalla
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michael Spiro
- Department of Anesthesia and Intensive Care Medicine, Royal Free Hospital, London, UK.,Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Dimitri Aristotle Raptis
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Andre M De Wolf
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William T Merritt
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
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12
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Greenstein YY, Guevarra K. Point-of-Care Ultrasound in the Intensive Care Unit: Applications, Limitations, and the Evolution of Clinical Practice. Clin Chest Med 2022; 43:373-384. [PMID: 36116807 DOI: 10.1016/j.ccm.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The use of point-of-care ultrasonography in the intensive care unit has been rapidly advancing over the past 20 years. This review will provide a broad overview of the discipline spanning lung ultrasonography to advanced critical care echocardiography. It will highlight new research that questions the utility of the inferior vena cava for determining volume responsiveness and will introduce the reader to cutting-edge technology including artificial intelligence, which is likely to revolutionize ultrasound teaching and image interpretation, increasing the reach of this modality for the frontline clinician.
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Affiliation(s)
- Yonatan Y Greenstein
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rutgers - New Jersey Medical School, University Hospital Building, Room I-354, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Keith Guevarra
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rutgers - New Jersey Medical School, University Hospital Building, Room I-354, 150 Bergen Street, Newark, NJ 07103, USA
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13
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Savvoulidis P, Moody WE, Steeds R, Ludman PF, Bradley JR, Singh A, Lawton E, Nadir MA, Doshi SN. A time-efficient protocol for transthoracic echocardiography during transfemoral transcatheter aortic valve implantation: early identification and effective management of intraprocedural complications. Echo Res Pract 2022; 9:3. [PMID: 35974389 PMCID: PMC9382780 DOI: 10.1186/s44156-022-00005-6] [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: 02/23/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractTransfemoral transcatheter aortic valve implantation (TAVI) under conscious sedation is the most widely used method of implantation. Echocardiography is used to detect complications and to assess the implantation result. The aim of this paper is to provide a time-efficient protocol when transthoracic echocardiography (TTE) is used to guide TAVI procedures.
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14
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Sanfilippo F, La Via L, Messina S, Lanzafame B, Dezio V, Astuto M. Caution Is Warranted When Assessing Diastolic Function Using Transesophageal Echocardiography. Comment on Kyle et al. Consensus Defined Diastolic Dysfunction and Cardiac Postoperative Morbidity Score: A Prospective Observational Study. J. Clin. Med. 2021, 10, 5198. J Clin Med 2022; 11:jcm11113105. [PMID: 35683492 PMCID: PMC9181419 DOI: 10.3390/jcm11113105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesiology and Intensive Care, AOU “Policlinico—San Marco” Catania, 95123 Catania, Italy; (L.L.V.); (V.D.); (M.A.)
- Correspondence: ; Tel.: +39-095-3782307
| | - Luigi La Via
- Department of Anesthesiology and Intensive Care, AOU “Policlinico—San Marco” Catania, 95123 Catania, Italy; (L.L.V.); (V.D.); (M.A.)
| | - Simone Messina
- School of Specialization in Anesthesiology and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Bruno Lanzafame
- Department of Anesthesiology and Intensive Care, AO “Umberto I”, ASP Siracusa, 96100 Siracusa, Italy;
| | - Veronica Dezio
- Department of Anesthesiology and Intensive Care, AOU “Policlinico—San Marco” Catania, 95123 Catania, Italy; (L.L.V.); (V.D.); (M.A.)
| | - Marinella Astuto
- Department of Anesthesiology and Intensive Care, AOU “Policlinico—San Marco” Catania, 95123 Catania, Italy; (L.L.V.); (V.D.); (M.A.)
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15
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Treibel TA, Kelion A, Ingram TE, Archbold RA, Myerson SG, Menezes LJ, Morgan-Hughes GJ, Schofield R, Keenan NG, Clarke SC, Keys A, Keogh B, Masani N, Ray S, Westwood M, Pearce K, Colebourn CL, Bull RK, Greenwood JP, Roditi GH, Lloyd G. United Kingdom standards for non-invasive cardiac imaging: recommendations from the Imaging Council of the British Cardiovascular Society. Heart 2022; 108:e7. [PMID: 35613713 DOI: 10.1136/heartjnl-2022-320799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heart and circulatory diseases affect more than seven million people in the UK. Non-invasive cardiac imaging is a critical element of contemporary cardiology practice. Progressive improvements in technology over the last 20 years have increased diagnostic accuracy in all modalities and led to the incorporation of non-invasive imaging into many standard cardiac clinical care pathways. Cardiac imaging tests are requested by a variety of healthcare practitioners and performed in a range of settings from the most advanced hospitals to local health centres. Imaging is used to detect the presence and consequences of cardiovascular disease, as well as to monitor the response to therapies. The previous UK national imaging strategy statement which brought together all of the non-invasive imaging modalities was published in 2010. The purpose of this document is to collate contemporary standards developed by the modality-specific professional organisations which make up the British Cardiovascular Society Imaging Council, bringing together common and essential recommendations. The development process has been inclusive and iterative. Imaging societies (representing both cardiology and radiology) reviewed and agreed on the initial structure. The final document therefore represents a position, which has been generated inclusively, presents rigorous standards, is applicable to clinical practice and deliverable. This document will be of value to a variety of healthcare professionals including imaging departments, the National Health Service or other organisations, regulatory bodies, commissioners and other purchasers of services, and service users, i.e., patients, and their relatives.
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Affiliation(s)
- Thomas A Treibel
- Cardiac Imaging, Saint Bartholomew's Hospital Barts Heart Centre, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Andrew Kelion
- Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Andrew Archbold
- General & Invasive Cardiology, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Saul G Myerson
- Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Leon J Menezes
- Department of Nuclear Cardiology, Barts Health NHS Trust, London, London, UK
| | | | - Rebecca Schofield
- Department of Cardiology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Niall G Keenan
- Department of Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Sarah C Clarke
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Bruce Keogh
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Navroz Masani
- Department of Cardiology, Cardiff and Vale NHS Trust, Cardiff, Cardiff, UK
| | - Simon Ray
- Cardiology, University Hospitals of South Manchester, Manchester, UK
| | - Mark Westwood
- Department of Cardiac Imaging, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| | - Keith Pearce
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - John Pierre Greenwood
- Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Giles H Roditi
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Guy Lloyd
- Department of Cardiac Imaging, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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16
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Tang MM, Fang DF, Liu B. Upper gastrointestinal bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography during successful cardiopulmonary resuscitation: A case report. World J Clin Cases 2022; 10:2954-2960. [PMID: 35434104 PMCID: PMC8968810 DOI: 10.12998/wjcc.v10.i9.2954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/05/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, it has been recognized that transesophageal echocardiography (TEE) is of great value in resuscitation of cardiac arrest. However, its safety has rarely been reported.
CASE SUMMARY We present a 59-year-old male patient scheduled to undergo cardiac surgery for rheumatic heart disease. Upper gastrointestinal bleeding from a Mallory-Weiss tear appeared following cardiopulmonary resuscitation, TEE, and percutaneous cardiopulmonary bypass resuscitation when he suffered from aesthesia-related cardiac arrest. Gastrointestinal injury was diagnosed promptly and treated effectively. However, the exact etiology of gastrointestinal injury was unclear; the interaction of closed-chest cardiac massage and the application of TEE may be involved as a most possible mechanism of injury.
CONCLUSION Serious complications should be considered when TEE is used in patients with special pathophysiological conditions.
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Affiliation(s)
- Miao-Miao Tang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Deng-Feng Fang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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17
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Leung LWM, Akhtar Z, Sheppard MN, Louis-Auguste J, Hayat J, Gallagher MM. Preventing esophageal complications from atrial fibrillation ablation: A review. Heart Rhythm O2 2022; 2:651-664. [PMID: 34988511 PMCID: PMC8703125 DOI: 10.1016/j.hroo.2021.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Atrioesophageal fistula is a life-threatening complication of ablation treatment for atrial fibrillation. Methods to reduce the risk of esophageal injury have evolved over the last decade, and diagnosis of this complication remains difficult and therefore challenging to treat in a timely manner. Delayed diagnosis leads to treatment occurring in the context of a critically ill patient, contributing to the poor prognosis associated with this complication. The associated mortality risk can be as high as 70%. Recent important advances in preventative techniques are explored in this review. Preventative techniques used in current clinical practice are discussed, which include high-power short-duration ablation, esophageal temperature probe monitoring, cryotherapy and laser balloon technologies, and use of proton pump inhibitors. A lack of randomized clinical evidence for the effectiveness of these practical methods are found. Alternative methods of esophageal protection has emerged in recent years, including mechanical deviation of the esophagus and esophageal temperature control (esophageal cooling). Although these are fairly recent methods, we discuss the available evidence to date. Mechanical deviation of the esophagus is due to undergo its first randomized study. Recent randomized study on esophageal cooling has shown promise of its effectiveness in preventing thermal injuries. Lastly, novel ablation technology that may be the future of esophageal protection, pulsed field ablation, is discussed. The findings of this review suggest that more robust clinical evidence for esophageal protection methods is warranted to improve the safety of atrial fibrillation ablation.
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Affiliation(s)
- Lisa W M Leung
- Department of Cardiology, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Zaki Akhtar
- Department of Cardiology, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Mary N Sheppard
- Cardiac Pathology Unit, St. George's University of London, London, United Kingdom
| | - John Louis-Auguste
- Department of Gastroenterology, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Jamal Hayat
- Department of Gastroenterology, St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark M Gallagher
- Department of Cardiology, St George's Hospital NHS Foundation Trust, London, United Kingdom
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18
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Murphy T, McCheyne A. Prospective national audit of major gastrointestinal complications of transesophageal echocardiography studies in children. Ann Card Anaesth 2022; 25:178-181. [PMID: 35417964 PMCID: PMC9244277 DOI: 10.4103/aca.aca_275_20] [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] [Indexed: 11/26/2022] Open
Abstract
Background: Perioperative trans-esophageal echocardiography ('TEE') is widely used for the assessment of anatomy/repair of congenital cardiac defects. It is recognised that there are risks associated with its use. Aims: We wished, by means of a contemporaneous prospective national audit over a six-month period, to establish what proportion of TEE studies in children are complicated by major upper gastrointestinal or upper aerodigestive tract trauma. Methods: After obtaining appropriate local institutional ethics committee approval, a national prospective audit of the rate and severity of gastrointestinal complications of trans-esophageal echocardiography studies in anaesthetised adult cardiology and cardiac surgical patients was conducted by the Association of Cardiothoracic Anaesthesia and Critical Care in the United Kingdom and Ireland during the twelve months of 2017. During the second six months of the audit, the Congenital Cardiac Anaesthesia Network (an organisation including anaesthetists with a paediatric cardiac anaesthetic practice in all the United Kingdom cardiac surgical centres) prospectively audited the incidence of such complications of TEE studies in children. Results: A total of 1,059 studies were included in this six-month paediatric audit. There were no reports of the specified major complication. Statistical Analysis: The zero incidence of the major complication is consistent with a worst possible incidence of five per thousand TEE examinations. Conclusions: Such potentially reassuring information could be included in discussions with patients or families about the risk of trans-esophageal studies in children.
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19
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Leung LWM, Bajpai A, Zuberi Z, Li A, Norman M, Kaba RA, Akhtar Z, Evranos B, Gonna H, Harding I, Sohal M, Al-Subaie N, Louis-Auguste J, Hayat J, Gallagher MM. Randomized comparison of oesophageal protection with a temperature control device: results of the IMPACT study. Europace 2021; 23:205-215. [PMID: 33205201 PMCID: PMC7868886 DOI: 10.1093/europace/euaa276] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/13/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023] Open
Abstract
Aims Thermal injury to the oesophagus is an important cause of life-threatening complication after ablation for atrial fibrillation (AF). Thermal protection of the oesophageal lumen by infusing cold liquid reduces thermal injury to a limited extent. We tested the ability of a more powerful method of oesophageal temperature control to reduce the incidence of thermal injury. Methods and results A single-centre, prospective, double-blinded randomized trial was used to investigate the ability of the ensoETM device to protect the oesophagus from thermal injury. This device was compared in a 1:1 randomization with a control group of standard practice utilizing a single-point temperature probe. In the protected group, the device maintained the luminal temperature at 4°C during radiofrequency (RF) ablation for AF under general anaesthesia. Endoscopic examination was performed at 7 days post-ablation and oesophageal injury was scored. The patient and the endoscopist were blinded to the randomization. We recruited 188 patients, of whom 120 underwent endoscopy. Thermal injury to the mucosa was significantly more common in the control group than in those receiving oesophageal protection (12/60 vs. 2/60; P = 0.008), with a trend toward reduction in gastroparesis (6/60 vs. 2/60, P = 0.27). There was no difference between groups in the duration of RF or in the force applied (P value range= 0.2–0.9). Procedure duration and fluoroscopy duration were similar (P = 0.97, P = 0.91, respectively). Conclusion Thermal protection of the oesophagus significantly reduces ablation-related thermal injury compared with standard care. This method of oesophageal protection is safe and does not compromise the efficacy or efficiency of the ablation procedure.
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Affiliation(s)
- Lisa W M Leung
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Abhay Bajpai
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Zia Zuberi
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Anthony Li
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Mark Norman
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Riyaz A Kaba
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Zaki Akhtar
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Banu Evranos
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Hanney Gonna
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Idris Harding
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Manav Sohal
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
| | - Nawaf Al-Subaie
- Anesthetic Department, Anesthesia and Intensive Care Medicine, Kuwait Oil Company Ahmadi Hospital, Kuwait
| | - John Louis-Auguste
- Department of Gastroenterology, St. George's University Hospitals NHS Foundation Trust, St. George's, London, UK
| | - Jamal Hayat
- Department of Gastroenterology, St. George's University Hospitals NHS Foundation Trust, St. George's, London, UK
| | - Mark M Gallagher
- Cardiology Department, Cardiology Clinical Academic Group, St. George's NHS Foundation Trust, London SW17 0QT, UK
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20
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Wahba A, Milojevic M, Boer C, De Somer FMJJ, Gudbjartsson T, van den Goor J, Jones TJ, Lomivorotov V, Merkle F, Ranucci M, Kunst G, Puis L. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg 2021; 57:210-251. [PMID: 31576396 DOI: 10.1093/ejcts/ezz267] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Milan Milojevic
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, Dedinje Cardiovascular Institute, Belgrade, Serbia.,Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christa Boer
- Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Jenny van den Goor
- Department of Cardiothoracic Surgery, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Vladimir Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk State University, Novosibirsk, Russia
| | - Frank Merkle
- Academy for Perfusion, Deutsches Herzzentrum, Berlin, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anaesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust and School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Luc Puis
- Department of Perfusion, University Hospital Brussels, Jette, Belgium
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21
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Denault AY, Roberts M, Cios T, Malhotra A, Paquin SC, Tan S, Cavayas YA, Desjardins G, Klick J. Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach. Anesth Analg 2021; 133:630-647. [PMID: 34086617 DOI: 10.1213/ane.0000000000005537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of transesophageal echocardiography (TEE) in the operating room and intensive care unit can provide invaluable information on cardiac as well as abdominal organ structures and function. This approach may be particularly useful when the transabdominal ultrasound examination is not possible during intraoperative procedures or for anatomical reasons. This review explores the role of transgastric abdominal ultrasonography (TGAUS) in perioperative medicine. We describe several reported applications using 10 views that can be used in the diagnosis of relevant abdominal conditions associated with organ dysfunction and hemodynamic instability in the operating room and the intensive care unit.
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Affiliation(s)
- André Y Denault
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Theodore Cios
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Anita Malhotra
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Sarto C Paquin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM)
| | - Stéphanie Tan
- Department of Radiology, Montreal Heart Institute, Université de Montréal
| | - Yiorgos Alexandros Cavayas
- Department of Medicine and Intensive Care Unit, Montreal Sacré-Coeur Hospital and Department of Medicine and Intensive Care Unit, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Davies EA, Templeton R. Tracheal tube obstruction as a complication of transoesophageal echocardiography. Anaesth Rep 2021; 9:110-113. [PMID: 34095852 DOI: 10.1002/anr3.12122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/06/2022] Open
Abstract
Complications of transoesophageal echocardiography are numerous and may have serious consequences. We present the case of a 31-year-old woman with postoperative airway obstruction secondary to a transesophageal echocardiography probe. The patient had been admitted with acute myocarditis and required temporary mechanical support with a biventricular assist device. She deteriorated on the intensive care unit several hours later with hypoxaemia, high airway pressures and reduced tidal volumes. Sedation was adequate and no external obstruction in the breathing circuit was observed. The tracheal tube was noted to be permanently deformed in the oropharynx, causing airway obstruction. Tracheal tube exchange was required, and the patient recovered from the event. We suspect that the position of the transoesophageal echocardiography probe in the operating theatre had contributed to the deformity, and the presence of airway obstruction was masked by the reduced ventilatory parameters instituted while on mechanical circulatory support. The biventricular assistance devices were explanted subsequently, and the patient was discharged home on day 31. This is the first reported case of a kinked tracheal tube where transoesophageal echocardiography probe placement was suspected to have contributed. A high index of suspicion is required for this complication on the intensive care unit.
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Affiliation(s)
- E A Davies
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO Wythenshawe Hospital Manchester UK
| | - R Templeton
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO Wythenshawe Hospital Manchester UK
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Leung LWM, Akhtar Z, Hayat J, Gallagher MM. Mechanical deviation of the esophagus: Not an easy concept to swallow. J Cardiovasc Electrophysiol 2021; 32:1209-1210. [PMID: 33651482 DOI: 10.1111/jce.14960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa W M Leung
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London, UK.,Department of Gastroenterology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Zaki Akhtar
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London, UK.,Department of Gastroenterology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Jamal Hayat
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London, UK.,Department of Gastroenterology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Mark M Gallagher
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London, UK.,Department of Gastroenterology, St. George's University Hospitals NHS Foundation Trust, London, UK
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Teran F, Prats MI, Nelson BP, Kessler R, Blaivas M, Peberdy MA, Shillcutt SK, Arntfield RT, Bahner D. Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 76:745-754. [PMID: 32762909 DOI: 10.1016/j.jacc.2020.05.074] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022]
Abstract
Focused transthoracic echocardiography (TTE) during cardiac arrest resuscitation can enable the characterization of myocardial activity, identify potentially treatable pathologies, assist with rhythm interpretation, and provide prognostic information. However, an important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. Over the last decade, focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis-those in cardiac arrest and periarrest states. In addition to the same diagnostic and prognostic role provided by TTE images, TEE provides unique advantages including the potential to optimize the quality of chest compressions, shorten cardiopulmonary resuscitation interruptions, guide resuscitative procedures, and provides a continuous image of myocardial activity. This review discusses the rationale, supporting evidence, opportunities, and challenges, and proposes a research agenda for the use of focused TEE in cardiac arrest with the goal to improve resuscitation outcomes.
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Affiliation(s)
- Felipe Teran
- Division of Emergency Ultrasound and Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Michael I Prats
- Division of Ultrasound, Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bret P Nelson
- Division of Ultrasound, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ross Kessler
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Michael Blaivas
- Department of Medicine, University of South Carolina School of Medicine. Department of Emergency Medicine, St. Francis Hospital, Columbia, South Carolina
| | - Mary Ann Peberdy
- Division of Cardiology, Department of Internal Medicine, Weil Institute of Emergency and Critical Care, Department of Emergency Medicine, University Virginia Commonwealth University, Richmond, Virginia
| | - Sasha K Shillcutt
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert T Arntfield
- Division of Critical Care Medicine, Western University, London, Ontario, Canada
| | - David Bahner
- Division of Ultrasound, Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Kumamoto T, Tashima K, Hiraoka C, Ikuta Y, Yamamoto T. McGRATH MAC video laryngoscope assistance during transesophageal echocardiography may reduce the risk of complications: a manikin study. BMC Anesthesiol 2021; 21:14. [PMID: 33430768 PMCID: PMC7798285 DOI: 10.1186/s12871-020-01231-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although transesophageal echocardiography (TEE) is considered a relatively safe diagnostic monitoring method, blind probe insertion is associated with pharyngeal trauma. Through visual observation of the esophageal inlet with the McGRATH video laryngoscope, it may be possible to insert the TEE probe at an appropriate angle and prevent pharyngeal trauma. We conducted a manikin study to investigate whether the use of the McGRATH video laryngoscope for TEE probe insertion reduced the pressure on the posterior pharyngeal wall. METHODS Twenty-seven junior (inexperienced group) and 10 senior (experienced group) anesthesiologists participated in this study. The TEE probe was inserted into an airway manikin in a blind fashion (blind group) or under visualization with the McGRATH (McGRATH group) video laryngoscope (three times each). A sealed bag filled with normal saline was placed on the back of the posterior pharyngeal wall of the manikin and connected to a patient monitoring system via a pressure transducer. We measured the internal bag pressure and approximated this value to the pressure on the posterior pharyngeal wall. RESULTS The pressure on the posterior pharyngeal wall was significantly lower in the McGRATH group than in the blind group (p < 0.001) and was significantly reduced when the McGRATH was employed in both the inexperienced (p < 0.001) and experienced (p < 0.001) groups. CONCLUSIONS These findings suggest that TEE probe insertion under the assistance of the McGRATH video laryngoscope can reduce the pressure on the posterior pharyngeal wall, regardless of the clinician's experience, and may inform clinical practice with the potential to reduce probe insertion-associated complication rates.
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Affiliation(s)
- Taisuke Kumamoto
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan.
| | - Koichiro Tashima
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Chieko Hiraoka
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Yoshihiro Ikuta
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
| | - Tatsuo Yamamoto
- Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, 860-8556, Kumamoto, Japan
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Hoshina R, Kishima H, Mine T, Ishihara M. Aortic dissection during transoesophageal echocardiography: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33628995 PMCID: PMC7891243 DOI: 10.1093/ehjcr/ytaa333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/15/2020] [Accepted: 09/02/2020] [Indexed: 11/14/2022]
Abstract
Background Transoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure. Case summary A 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS2 score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery. Discussion Transoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk–benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.
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Affiliation(s)
- Rin Hoshina
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Hideyuki Kishima
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Takanao Mine
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
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Leung LW, Gallagher MM. Letter in reply to Gianni et al on “Prevention, diagnosis, and management of atrioesophageal fistula”. Pacing Clin Electrophysiol 2020; 43:1417-1418. [DOI: 10.1111/pace.14012] [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: 06/02/2020] [Accepted: 06/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Lisa W.M. Leung
- Cardiology Clinical Academic Group St George's NHS Foundation Trust London UK
| | - Mark M. Gallagher
- Cardiology Clinical Academic Group St George's NHS Foundation Trust London UK
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Leung LW, Gallagher MM. Esophageal cooling for protection: an innovative tool that improves the safety of atrial fibrillation ablation. Expert Rev Med Devices 2020; 17:981-982. [PMID: 32933326 DOI: 10.1080/17434440.2020.1824674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This letter to the editor concerns the article: 'Innovative tools for atrial fibrillation ablation' by Rottner et al., published in the journal on 13th of May 2020. We read the article with great interest and congratulate the authors on an impressively detailed summary of the current tools and technological advances in atrial fibrillation ablation. Improving the safety of this procedure is very important due to widespread clinical practice and the increasing demand for this procedure. We would like to share further discussion with the authors and the journal's readership on current advances in improving the safety of this procedure - esophageal cooling. The results of a large randomized trial was recently presented, the IMPACT study (NCT03819946), which showed that a simple, standardized method of esophageal cooling with the ensoETM® device can significantly reduce esophageal thermal injury by 83.4%. Esophageal protection is important as esophageal injury has a high mortality rate to those that sustain this injury although the overall incidence is low. Rottner et al. discuss a much smaller study on esophageal cooling and the limitations of this study are also discussed.
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Affiliation(s)
- Lisa Wm Leung
- Cardiology Clinical Academic Group, St George's NHS Foundation Trust , London, UK
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St George's NHS Foundation Trust , London, UK
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). ACTA ACUST UNITED AC 2020; 67:446-480. [PMID: 32948329 DOI: 10.1016/j.redar.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
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Affiliation(s)
- P Carmona García
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Coordinadora del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SEDAR
| | - R García Fuster
- Servicio de Cirugía Cardiaca, Consorcio Hospital General Universitario de Valencia, España. Coordinador del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SECCE.
| | - E Mateo
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - S Badía Gamarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Trías y Pujol, Badalona, España
| | - M López Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España
| | - E Gutiérrez Carretero
- Servicio de Cirugía Cardiaca, Hospital, Universitario Virgen del Rocío, Sevilla, España
| | - M L Maestre
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - V Legname
- Servicio de Cirugía Cardiaca, Centro Médico Teknon, Barcelona, España
| | - G Fita
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación. Hospital Clínic, Barcelona, España
| | - M Vives
- EDAIC. PhD. Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Universitario Dr Josep Trueta de Girona, España. Representante de España en la EACTA. Co-director del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Representante del subcomité de Educación de EACTA. Co-director grupo EchoSim
| | - T Koller Bernhard
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - E Sánchez Pérez
- EDAIC. Sección de Cirugía Cardiaca, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR
| | - J Miralles Bagán
- Sección Cardiotorácica, Servicio Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - S Italiano
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - B Darias-Delbey
- Servicio Anestesiología y Reanimación, Proceso del Paciente, Cardioquirúrgico, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, España
| | - J M Barrio
- Sección Anestesia y Reanimación Cardiovascular, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Hortal
- Servicio de Anestesiología y Reanimación, Hospital General. Universitario Gregorio Marañón, Madrid, España
| | - J I Sáez de Ibarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - A Hernández
- Departamento de Anestesia y Cuidados Intensivos, Grupo Policlínica, Ibiza, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos, de la SEDAR Representante del subcomité de Educación de EACTA, EDAIC, Codirector grupo EchoSim
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Abstract
Purpose of Review This article summarizes the utility and evidence supporting the use of ultrasound exams in the intensive care unit. Recent Findings Point-of-care ultrasonography (POCUS) is widely used by intensivists managing critically ill patients whereby they can accurately and rapidly assess for many pathologies such as pneumothorax, pulmonary edema, hydronephrosis, hemoperitoneum, and deep vein thrombosis among others. Basic and advanced critical care echocardiography, including transesophageal echocardiography, are routinely performed to determine the etiology of hemodynamic instability in undifferentiated shock and to guide subsequent therapy. The use of POCUS in the assessment of volume status is controversial with studies demonstrating that respiratory variation of the IVC is not reliable and with analysis of aortic blood flow velocity after passive leg raising maneuvers being the most promising. Summary Point-of-care ultrasonography allows frontline clinicians to make real-time diagnoses and treatment decisions. This article will provide the reader with a broad overview of this important topic. Electronic supplementary material The online version of this article (10.1007/s11886-020-01393-z) contains supplementary material, which is available to authorized users.
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Smith BB, Rehfeldt KH, Meinhardt JR, Smith MM. Safety and feasibility of transesophageal echocardiography in patients with prior esophageal surgery. Echocardiography 2020; 37:1430-1435. [PMID: 32860254 DOI: 10.1111/echo.14840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Transesophageal echocardiography (TEE) is a specialized form of cardiac ultrasound and has been associated with rare but serious complications. In patients with prior esophageal surgery, the risk of esophageal damage or the inability to perform a comprehensive and successful TEE warrants further evaluation. METHODS Retrospective study of patients with prior esophageal surgery who underwent TEE between June 21, 2002 and October 15, 2019. Medical and echocardiographic records were reviewed for image quality and procedural complications. Post-procedure complications and 30-day all-cause mortality were collected. Evaluation by gastroenterology (GI), otolaryngology/ear, nose, throat (ENT), or thoracic surgery (TS) within 30 days of TEE was reviewed in detail. RESULTS Ninety-five patients with prior esophageal surgery underwent 145 TEEs. The most commonly performed esophageal procedures were anti-reflux operations (89%). TEE image quality was degraded in 16% while transgastric imaging was not completed in 37% of cases. A comprehensive TEE was completed in 57% of patients with diagnostic study goals achieved in 96% of cases. Comments describing procedural difficulty were reported in 6% while comments on procedural complications occurred in 1% of cases. Post-procedure complications occurred in 1% of patients including hypotension and unplanned hospital/ICU admission. CONCLUSIONS Concern for esophageal damage and the inability to perform a comprehensive and diagnostic TEE may limit the usefulness of TEE in patients with prior esophageal surgery. While TEE-associated complications were rare in this series, a conservative approach with a thorough pre-procedure assessment, including multi-disciplinary evaluation when appropriate, is prudent in this complex cohort of patients.
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Affiliation(s)
- Bradford B Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
| | - Kent H Rehfeldt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Shah R, Pulton D, Wenger RK, Ha B, Feinman JW, Patel S, Lau C, Rong LQ, Weiss SJ, Augoustides JG, Daubenspeck D, Chaney MA. Aortic Dissection During Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:323-331. [PMID: 32928651 DOI: 10.1053/j.jvca.2020.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ronak Shah
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle Pulton
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert K Wenger
- Division of Cardiac Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Division of Cardiac Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Stuart J Weiss
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danisa Daubenspeck
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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34
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Royer O, Couture ÉJ, Nicodème F, Kalavrousiotis D, Maruyama TC, Denault A, Langevin S. Esophageal Perforation with Transesophageal Echocardiography in an Elderly Patient with Prominent Vertebral Osteophytes: A Case Report and a Review of the Literature. ACTA ACUST UNITED AC 2020; 4:331-336. [PMID: 33117922 PMCID: PMC7581634 DOI: 10.1016/j.case.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Iatrogenic esophageal perforation due to TEE is associated with high mortality. Vertebral osteophytes are a common radiologic finding in elderly patients. Pressure applied by the TEE probe on osteophytes can lead to esophageal laceration. Preoperative imaging should be reviewed before performing TEE. Severe osteophytosis in the elderly may be a relative contraindication to TEE.
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Affiliation(s)
- Olivier Royer
- Department of Anesthesiology and Critical Care, Université Laval, Québec, Québec, Canada
| | - Étienne J Couture
- Department of Anesthesiology and Critical Care, Université Laval, Quebec Heart and Lung Institute, Québec, Québec, Canada
| | - Frédéric Nicodème
- Department of Thoracic Surgery, Université Laval, Quebec Heart and Lung Institute, Québec, Québec, Canada
| | - Dimitri Kalavrousiotis
- Department of Cardiac Surgery, Université Laval, Quebec Heart and Lung Institute, Québec, Québec, Canada
| | - Takumi Codere Maruyama
- Department of Anesthesiology, Université Laval, Quebec Heart and Lung Institute, Québec, Québec, Canada
| | - André Denault
- Department of Anesthesiology and Critical Care, Université de Montréal, Montreal Heart Institute, Montréal, Québec, Canada
| | - Stephan Langevin
- Department of Anesthesiology and Critical Care, Université Laval, Quebec Heart and Lung Institute, Québec, Québec, Canada
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Kendall S, O'Keeffe N. Strategies to eradicate resternotomy after cardiac surgery from clinical practice. Anaesthesia 2020; 76:3-5. [PMID: 32683678 DOI: 10.1111/anae.15182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Society for Cardiothoracic Surgery Great Britain, and Ireland, Middlesbrough, UK
| | - N O'Keeffe
- Department of Anaesthesia and Intensive Care, Manchester Royal Infirmary, Association for Cardiothoracic Anaesthesia and Critical Care, Manchester, UK
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Flower L, Dempsey M, White A, Sanfilippo F, Olusanya O, Madhivathanan PR. Training and Accreditation Pathways in Critical Care and Perioperative Echocardiography. J Cardiothorac Vasc Anesth 2020; 35:235-247. [PMID: 32768252 DOI: 10.1053/j.jvca.2020.07.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
In recent years, there has been a dramatic rise in the use of echocardiography in perioperative and critical care medicine. It is now recommended widely as a first-line diagnostic tool when approaching patients in shock, due to its ability to identify shock etiology and response to treatment noninvasively. To match the increasing training demand, and to ensure maintenance of high-quality and reproducible scanning, several accreditation pathways have been developed worldwide. Critical care echocardiography training pathways can include both transthoracic and transesophageal scanning and range from basic focused protocols to advanced comprehensive scans. The complexity of each individual training program is reflected in its accreditation process. While basic accreditations may require only course attendance and a relatively brief logbook, comprehensive accreditations often require extensive logbooks and written and practical examinations. Currently, the use of transoesophageal echocardiography remains restricted largely to cardiothoracic anesthesia and critical care; however, its use in the general intensive care setting is growing. This narrative review summarizes the most common training pathways, their curricula, and accreditation requirements. The authors initially focus on echocardiography training in the United Kingdom, and then go on to describe similar international accreditations available in Europe, North America, and Australasia.
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Affiliation(s)
- Luke Flower
- Department of Anaesthesia, University College London Hospitals NHS Trust, London, United Kingdom.
| | - Martin Dempsey
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Alexander White
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Pradeep R Madhivathanan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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Hessel EA, Groom RC. Guidelines for Conduct of Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2020; 35:1-17. [PMID: 32561248 DOI: 10.1053/j.jvca.2020.04.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Eugene A Hessel
- Department of Anesthesiology University of Kentucky Lexington, KY
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Namekawa M, Tsujimoto Y, Banno M, Kataoka Y, Tsujimoto H, Inaba Y, Fujiwara T. Videolaryngoscopy for transesophageal echocardiography probe insertion: a systematic review and meta-analysis of randomized controlled trials. J Anesth 2020; 34:453-463. [PMID: 32219541 DOI: 10.1007/s00540-020-02759-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
Transesophageal echocardiography (TEE) is a well-established procedure, but serious complications may occur. This systematic review and meta-analysis assessed the utility of videolaryngoscopy-assisted technique in TEE probe insertion. We performed a systematic search in MEDLINE, EMBASE, CENTRAL, and ICTRP. We included RCTs comparing TEE probe insertion techniques assisted with videolaryngoscopy and with any other insertion technique in adult patients. Primary outcome measures were (1) the number of attempts before successful TEE probe insertion, and (2) the risk of any procedural injury to related structures. The secondary outcome measure was time to TEE probe insertion. In total, three studies (n = 266) were included in this systematic review. Overall, a significantly less number of attempts were required with videolaryngoscopy-assisted insertion (mean difference [MD] - 0.60; 95% confidence interval [CI] - 0.73, - 0.46; low quality of evidence). Videolaryngoscopy-assisted technique was also associated with smaller risk of complications (risk ratio [RR] 0.17; 95% CI 0.05, 0.62; low quality of evidence). There was no significant difference in time to probe insertion (MD - 8.57; 95% CI - 26.31, 9.16; very low quality of evidence). The use of videolaryngoscopy for TEE probe insertion is associated with a significant reduction in the number of attempts and complication rate.
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Affiliation(s)
- Motoki Namekawa
- Department of Critical Care Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan.
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Hyogo, Japan
| | - Masahiro Banno
- Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Hiraku Tsujimoto
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yu Inaba
- Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Fujiwara
- Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
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Ashworth AD, Greenhalgh DL. Strategies for the prevention of peri‐operative transoesophageal echocardiography‐related complications. Anaesthesia 2019; 75:3-6. [DOI: 10.1111/anae.14772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2019] [Indexed: 12/31/2022]
Affiliation(s)
- A. D. Ashworth
- Department of Cardiothoracic Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust Manchester UK
| | - D. L. Greenhalgh
- Department of Cardiothoracic Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust Manchester UK
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Clinical News. Br J Hosp Med (Lond) 2019; 80:368-369. [PMID: 31283402 DOI: 10.12968/hmed.2019.80.7.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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