THE INFLUENCE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY ON INTRAOPERATIVE DECISION-MAKING - A EUROPEAN MULTICENTER STUDY

The role of transoesophageal echocardiography (TOE) in anaesthesia rem ains controversial because it is a rapidly evolving technique with few proven benefits and considerable cost. Recently, the Society of Cardi ovascular Anaesthesiologists has published practice guidelines for the use of peri-operative TOE. To determine the current role of transoeso phageal echocardiography and the relative impact of category-based tra nsoesophageal echocardiographic indications the present study investig ated its use in seven Western European countries. The study sample was taken from a prospective cohort of 224 patients with acute or chronic haemodynamic disturbances or at risk of myocardial ischaemia. All pat ients were monitored with two-lead electrocardiography and radial and pulmonary artery catheters, as well as biplane or multiplane transoeso phageal echocardiography. A total of 2232 clinical interventions were made in these patients. The most frequently observed intervention was the administration of a fluid bolus (45% of all interventions). Overal l, transoesophageal echocardiography was the most important guiding fa ctor in 560 (25%) interventions. It was the most important monitor in guiding the following therapeutic interventions: anti-ischaemic therap y - 207 of 372 interventions (56%); fluid administration 275 of 996 (2 8%) interventions; vasopressor or inotrope administration - 56 of 316 (16%) interventions; vasodilator therapy - six of 142 (4%) interventio ns and depth of anaesthesia four of 211 (2%) interventions. We found t hat transoesophageal echocardiography is frequently influential in gui ding clinical decision making and is used most frequently for category II indications but category I indications were associated with more f requent change in management.