Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic - 03/08/20
, Katharine M. Burns, MD b, c, Mangala Narasimhan, DO d, Alberto Goffi, MD e, f, Paul Mohabir, MD g, James M. Horowitz, MD h, Eugene Yuriditsky, MD h, Arun Nagdev, MD i, Nova Panebianco, MD, MPH j, Eric J. Chin, MD, MBA k, Michael Gottlieb, MD l, Seth Koenig, MD m, Robert Arntfield, MD n
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Abstract |
Background |
The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goal-directed transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside.
Methods |
A multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic.
Results |
Although transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination.
Conclusions |
In the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | TEE as an invaluable tool for managing the critically ill patient with COVID-19. |
• | TEE can be useful when adequate TTE windows cannot be obtained. |
• | TEE can be useful to address hemodynamic instability during prone ventilation. |
• | TEE allows to perform serial evaluations of the lungs. |
• | TEE is useful to guide critical care procedures such veno-venous ECMO cannulation. |
Keywords : COVID-19, Novel coronavirus, SARS-CoV-2, Acute respiratory syndrome associated with COVID-19, Transesophageal echocardiography, Point-of-care ultrasound
Abbreviations : AGP, ARDS, COVID-19, ECMO, ICU, PE, SARS-CoV-2, SVC, TEE, TELUS, TTE
Plan
| Dr. Teran has received consulting honoraria payments from Fujifilm Sonosite and Philips Healthcare for participation in educational events and expert panels related to point-of-care ultrasound, including transesophageal echocardiography, and he is the owner of ResusMedX. Dr. Koenig has received consulting honoraria from Fujifilm Sonosite for an educational lecture on transesophageal echocardiography in critical care during the 2019 annual meeting of the American College of Chest Physicians. Dr. Arntfield has received consulting honoraria payments from Philips Healthcare and Fujifilm Sonosite and is a member of the medical advisory boards for EchoNous and Vave Health. The views expressed in this document are those of the author (s) and do not reflect the official policy of the US Department of the Army, the US Department of Defense, or the US government. |
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| Conflicts of Interest: None. |
Vol 33 - N° 8
P. 1040-1047 - août 2020 Retour au numéro
Article précédent
- ASE Statement on the Reintroduction of Echocardiographic Services during the COVID-19 Pandemic
- Judy Hung, Theodore P. Abraham, Meryl S. Cohen, Michael L. Main, Carol Mitchell, Vera H. Rigolin, Madhav Swaminathan
- New Challenges and Opportunities for Echocardiographic Education during the COVID-19 Pandemic: A Call to Focus on Competency and Pathology
- Jose A. Madrazo
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