Transesophageal echocardiography (TEE) was considered to be a valuable tool for the assessment and management of patients with coronavirus disease 2019 (COVID-19) in critical care, according to a consensus statement published in the Journal of the American Society of Echocardiography.
A multidisciplinary team of experts in point-of-care echocardiography from the United States and Canada gathered to review evidence, share experiences, and provide recommendations for clinicians to optimize the safety of patients and staff when considering TEE in patients in critical care with COVID-19.
TEE offers healthcare professionals caring for intubated critically ill patients a high-quality imaging modality that allows to answer goal-directed questions that can impact decision making at the bedside. The American Society of Echocardiography guidelines on TEE in the preoperative setting during COVID-19, do not address the use of this modality in critical care. Here, the authors aimed to offer a practical framework to physicians for the management of critically ill patients with COVID-19.
Their recommendations include the following:
- To reduce the risk for viral transmission during TEE, consider the data provided by similar endoscopic procedures, as some of the same safety principles can be used. Appropriate personal protective equipment is a priority when performing TEE, including powered air purifying respiratory.
- Conduct team huddle outside the patient’s room to discuss the indication and goals, define roles, and address specific actions to take in order to maximize the safety of providers.
- High-level disinfection must be performed on all TEE transducers between each use.
- TEE can be useful when acceptable TTE windows cannot be obtained, when there is need to address hemodynamic instability during prone ventilation, during cardiac arrest resuscitation, to perform serial evaluations of the lungs, and to guide veno-venous extra corporeal membrane oxygenation cannulation.
The recommendations provided in this report represent the authors’ opinions. In addition, the report has not been commissioned by any professional society.
“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 patient,” concluded the report authors.
Teran F, Burns KM, Narasimhan M, Goffi A, Mohabir P, Horowitz JM. Critical care transesophageal echocardiography in patients during the COVID-19 pandemic (published online May 11, 2020). J Am Soc Echocardiogr. https://doi.org/10.1016/j.echo.2020.05.022