Use of rapid "rescue" perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients

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Abstract

Objective: To investigate if modified "rescue" echocardiography enhanced management during perioperative hemodynamic instability in patients undergoing noncardiac surgery. Design: A retrospective analysis of the medical data. Setting: Perioperative setting at a single academic medical center. Participants: Thirty-one adult patients undergoing noncardiac surgery who experienced perioperative hemodynamic instability and were evaluated by either transthoracic echocardiography (TTE, n = 9) or transesophageal echocardiography (TEE, n = 22). Interventions: None. Measurements and Main Results: Rapid "rescue" echocardiography was performed on each patient looking for a specific cause for the patient's perioperative compromise. Echocardiography results, medical management, surgical management, and patient outcomes were all reviewed from the medical record and the department database. All patients were found to have an explainable diagnosis for the hemodynamic instability on the echocardiographic examination. The most common diagnoses were left-heart dysfunction (n = 16), right-heart dysfunction (n = 9), hypovolemia (n = 5), pulmonary embolus (n = 5), and myocardial ischemia (n = 4). Based on findings at echocardiography, 4 patients (13%) underwent and survived an emergent secondary procedure. All 31 patients recovered during their surgical procedure, and 25 (81%) progressed to hospital discharge. Conclusions: Both TTE and TEE can play a critical role in the diagnosis and management of perioperative hemodynamic instability.

Original languageEnglish (US)
Pages (from-to)362-370
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume26
Issue number3
DOIs
StatePublished - Jun 1 2012

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Echocardiography
Hemodynamics
Hospital Medical Records Department
Hypovolemia
Transesophageal Echocardiography
Embolism
Myocardial Ischemia
Databases
Lung

Keywords

  • monitoring echocardiography
  • noncardiac surgery
  • resuscitation
  • transesophageal echocardiography
  • transthoracic echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

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abstract = "Objective: To investigate if modified {"}rescue{"} echocardiography enhanced management during perioperative hemodynamic instability in patients undergoing noncardiac surgery. Design: A retrospective analysis of the medical data. Setting: Perioperative setting at a single academic medical center. Participants: Thirty-one adult patients undergoing noncardiac surgery who experienced perioperative hemodynamic instability and were evaluated by either transthoracic echocardiography (TTE, n = 9) or transesophageal echocardiography (TEE, n = 22). Interventions: None. Measurements and Main Results: Rapid {"}rescue{"} echocardiography was performed on each patient looking for a specific cause for the patient's perioperative compromise. Echocardiography results, medical management, surgical management, and patient outcomes were all reviewed from the medical record and the department database. All patients were found to have an explainable diagnosis for the hemodynamic instability on the echocardiographic examination. The most common diagnoses were left-heart dysfunction (n = 16), right-heart dysfunction (n = 9), hypovolemia (n = 5), pulmonary embolus (n = 5), and myocardial ischemia (n = 4). Based on findings at echocardiography, 4 patients (13{\%}) underwent and survived an emergent secondary procedure. All 31 patients recovered during their surgical procedure, and 25 (81{\%}) progressed to hospital discharge. Conclusions: Both TTE and TEE can play a critical role in the diagnosis and management of perioperative hemodynamic instability.",
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N2 - Objective: To investigate if modified "rescue" echocardiography enhanced management during perioperative hemodynamic instability in patients undergoing noncardiac surgery. Design: A retrospective analysis of the medical data. Setting: Perioperative setting at a single academic medical center. Participants: Thirty-one adult patients undergoing noncardiac surgery who experienced perioperative hemodynamic instability and were evaluated by either transthoracic echocardiography (TTE, n = 9) or transesophageal echocardiography (TEE, n = 22). Interventions: None. Measurements and Main Results: Rapid "rescue" echocardiography was performed on each patient looking for a specific cause for the patient's perioperative compromise. Echocardiography results, medical management, surgical management, and patient outcomes were all reviewed from the medical record and the department database. All patients were found to have an explainable diagnosis for the hemodynamic instability on the echocardiographic examination. The most common diagnoses were left-heart dysfunction (n = 16), right-heart dysfunction (n = 9), hypovolemia (n = 5), pulmonary embolus (n = 5), and myocardial ischemia (n = 4). Based on findings at echocardiography, 4 patients (13%) underwent and survived an emergent secondary procedure. All 31 patients recovered during their surgical procedure, and 25 (81%) progressed to hospital discharge. Conclusions: Both TTE and TEE can play a critical role in the diagnosis and management of perioperative hemodynamic instability.

AB - Objective: To investigate if modified "rescue" echocardiography enhanced management during perioperative hemodynamic instability in patients undergoing noncardiac surgery. Design: A retrospective analysis of the medical data. Setting: Perioperative setting at a single academic medical center. Participants: Thirty-one adult patients undergoing noncardiac surgery who experienced perioperative hemodynamic instability and were evaluated by either transthoracic echocardiography (TTE, n = 9) or transesophageal echocardiography (TEE, n = 22). Interventions: None. Measurements and Main Results: Rapid "rescue" echocardiography was performed on each patient looking for a specific cause for the patient's perioperative compromise. Echocardiography results, medical management, surgical management, and patient outcomes were all reviewed from the medical record and the department database. All patients were found to have an explainable diagnosis for the hemodynamic instability on the echocardiographic examination. The most common diagnoses were left-heart dysfunction (n = 16), right-heart dysfunction (n = 9), hypovolemia (n = 5), pulmonary embolus (n = 5), and myocardial ischemia (n = 4). Based on findings at echocardiography, 4 patients (13%) underwent and survived an emergent secondary procedure. All 31 patients recovered during their surgical procedure, and 25 (81%) progressed to hospital discharge. Conclusions: Both TTE and TEE can play a critical role in the diagnosis and management of perioperative hemodynamic instability.

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