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Multicenter Study
. 2020 Jan;75(1):21-26.
doi: 10.1111/anae.14734. Epub 2019 Jun 24.

Complications related to peri-operative transoesophageal echocardiography - a one-year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care

G Ramalingam  1 , S-W Choi  2 , S Agarwal  3 , G Kunst  4 , R Gill  5 , S N Fletcher  6 , A A Klein  1 ; Association of Cardiothoracic Anaesthesia and Critical Care
Collaborators, Affiliations
Free article
Multicenter Study

Complications related to peri-operative transoesophageal echocardiography - a one-year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care

G Ramalingam et al. Anaesthesia. 2020 Jan.
Free article

Abstract

Previous studies on the safety of peri-operative transoesophageal echocardiography seem to suggest a low rate of associated morbidity and mortality. That said, there has been a paucity of prospective multicentre studies in this important area of clinical practice. We carried out a one-year prospective study in 2017, co-ordinated by the Association of Cardiothoracic Anaesthesia and Critical Care, to determine the rate and severity of complications associated with peri-operative transoesophageal echocardiography in anaesthetised cardiology and cardiac surgical patients. With the help of clinicians from 28 centres across the UK and Ireland, we recorded the total number of examinations conducted in anaesthetised patients during the study period. All major complications at each centre were prospectively reported and recorded. Of the 22,314 examinations, there were 17 patients diagnosed with a major complication which caused either palatal injury or gastro-oesophageal disruption. This corresponds to an incidence of 0.08% (95%CI 0.05-0.13%) or approximately 1:1300 examinations. There were seven deaths reported during the study period which were directly attributed to these complications, corresponding to an incidence of 0.03% (95%CI 0.01-0.07%) or approximately 1:3000. These figures are higher than previously reported and suggest a high probability of death following the development of a complication (~40%). Most complications occurred in patients without known risk factors for transoesophageal echocardiography associated gastro-oesophageal injury. We suggest clinicians and departments review their procedural guidelines, especially in relation to probe insertion techniques, together with the information communicated to patients when the risks and benefits of such examinations are discussed.

Keywords: cardiac surgery; complications; morbidity; patient safety; transoesophageal echocardiography.

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References

    1. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesthesia and Analgesia 2014; 11: 21-68.
    1. Dobbs HA, Bennett-Guerrero E, White W, et al. Multinational institutional survey on patterns of intraoperative transesophageal echocardiography use in adult cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2014; 28: 54-63.
    1. American Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology 2010; 112: 1084-96.
    1. Klein AA, Snell A, Nashef SA, Hall RM, Kneeshaw JD, Arrowsmith JE. The impact of intra-operative transoesophageal echocardiography on cardiac surgical practice. Anaesthesia 2009; 64: 947-52.
    1. Eltzschig HK, Rosenberger P, Loffler M, Fox JA, Aranki SF, Shernan SK. Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery. Annals of Thoracic Surgery 2008; 85: 845-52.

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