A review of 364 perioperative rescue echocardiograms: findings of an anesthesiologist-staffed perioperative echocardiography service

Abstract

Objective: Review the findings and use of rescue echocardiography performed by the Division of Perioperative Echocardiography and its impact on patient management.

Design: Retrospective observational study.

Setting: Single institution, tertiary care hospital.

Participants: Three hundred sixty-four consecutive rescue echocardiograms in the perioperative setting.

Interventions: Rescue transesophageal or rescue transthoracic echocardiography.

Measurements and main results: Of a total of 1,675 perioperative echocardiograms performed in a 28-month period, 364 (21.8%) were rescue studies. Of these, 95.9% were transesophageal and 4.1% were transthoracic. Location at time of rescue echocardiography was intraoperative (55.5%), postoperative (44.2%), and preoperative (0.3%). No single diagnosis predominated the intraoperative or postoperative environment, and the frequency of common etiologies did not allow for assumption. There was a change in management for 214 patients (59%) as the result of findings. The methods used in performing rescue echocardiography at the authors' institution are reported.

Conclusions: The heterogeneity of diagnoses and the frequency with which rescue echocardiography changed management further supports the growing body of evidence that the hemodynamically unstable perioperative patient benefits from its use.

Keywords: hemodynamic instability; intraoperative hypotension; rescue echocardiography; transesophageal echocardiography; transthoracic echocardiography.