The Efficacy of Transesophageal and Transthoracic Echocardiography during Perioperative Cardiovascular Adverse Events in Noncardiac Surgery

Abstract

Routine echocardiography is used every day to manage patients undergoing complex cardiac interventions in many health centers; however, the use of echocardiography to aid in the diagnosis, management and treatment of cardiopulmonary arrest has not been thoroughly studied. Despite recent guidelines established by the American Society of Anesthesiology and Society of Cardiovascular Anesthesiology for the use of echocardiography in patients with intraoperative hemodynamic collapse, institutional protocols for implementing echocardiography perioperatively are lacking. We report a retrospective study of 31 patients undergoing noncardiac surgery that suffered hemodynamic collapse perioperatively and underwent either transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). A routine, standard rapid rescue echocardiogram exam was performed on each patient looking for specific diagnosis by echo-trained physicians. Echocardiography results, medical and surgical management, and patient outcomes were all reviewed and reported from the medical record and our department database. Undiagnosed left heart failure, acute right heart failure, myocardial ischemia, hypovolemia, and pulmonary embolus were the most commonly found diagnosis on echocardiography. All patients were found to have an explainable diagnosis for their cardiac instability on echo exam as described by the physician at the time of the arrest. Twenty-nine of 31 patients (94%) survived their surgical procedure, while 24/31 (77%) survived hospital discharge. Four patients eventually underwent a secondary procedure based on findings on echocardiography, and all survived the secondary procedure. Both TTE and TEE, which have the ability to diagnose causes of cardiopulmonary arrest, may play a significant role in the critical medical and surgical management of patients during times of perioperative resuscitation.