Search results for 'tee'

TEE in the ICU: ECMO Management

8 Nov

Here at Western we use a fair amount of TEE in resuscitation in the ICU, the ED and the trauma bay.  The below video highlights the utility of seeing the heart and guiding procedures in the context of a complex critically ill patient receiving extra-corporeal membrane oxygenation (ECMO).  This is a “photo essay” so there is no sound (your volume isn’t broken!).  We hope to publish more or our illustrative cases that demonstrate the value of TEE at the bedside for your critically ill patients.  Stay tuned.

Critical Care Transesophageal Echocardiography (TEE)

3 Oct

For most point-of-care needs, one can do both basic and more advanced applications of echocardiography with transthoracic scanning. However, there ARE times whereby having ability to perform transesophageal echocardiography (TEE) can be extremely helpful in the point-of-care.

This is especially true when windows are hard to obtain in transthoracic echo (TTE) during a technically difficult study, or when a more sensitive and specific modality is required to help with various diagnoses (i.e. endocarditis, cardiac source of emboli, shunts, dissection), or during procedural guidance (i.e. veno-venous extracorporeal membrane oxygenation insertion).

In this series of case presentations, Dr. Vincent Lau, critical care medicine alumnus and critical care ultrasound fellow at Western University, introduces various advanced concepts with regards to performing critical care TEEs.

Case 1: Left Atrial Appendage Thrombus/Emboli

Case 2: Endocarditis

Case 3: Veno-Venous ECMO Initiation

Case 4: Shunts (Atrial Septal Defects & Patent Foramen Ovale) and Bubble Study

TEE for VV-ECMO Initiation

14 Sep

Veno-venous ECMO use is increasing at many centres.  Seldom an elective procedure and typically done on patients too sick to transport, bedside guidance of ECMO cannula insertion is essential.

As this tutorial (by Dr. Vince Lau) highlights, point-of-care TEE can be invaluable in these circumstances in providing real time guidance of guidewire and cannula positioning.  Further, adjustments of the cannula’s outflow port can be done using color Doppler to optimize the yield of the intervention.

Case #6 – ED TEE for Cardiac Arrest

27 Jan

In this case a sudden deterioration in the emergency department prompts a TTE which shows some concerning physiology.  It is not until the TEE is inserted, however, that the culprit disease can be identified.

*Images courtesy of Dr. Drew Thompson, Division of EM, Western University

Case Highlights:

*TEE in the ED is valuable for critically ill patients

*TEE has advanced diagnostic potential, including the identification of aortic dissection in a rare number of cases

*TEE has value in cardiac arrest in particular for its ability to provide all the benefits of echocardiography (identification of reversible causes, prognostication, subjective and objective evaluation of CPR quality) without any need to interrupt chest compressions

TEE in the Emergency Department

14 Nov

The transesophageal approach echocardiography has numerous advantages for those providing resuscitation to the critically ill, including those with cardiac arrest.  While the transthoracic approach is often quite useful, quality images in ventilated patients are more challenging.  Thus, the reliable, high quality image acquisition of TEE is very attractive for the resus room.  It is, however, the continuous nature of TEE – due to the probe being left in-situ throughout the resuscitation – that makes this the ideal tool for the resuscitator.  Continuous, live updates on the functional and hemodynamic evolution during a resuscitation, including during CPR, is a sublime experience for anybody who has used this approach.

Given these obvious advantages, it is important that emergency physicians be enabled and empowered to engage in this method of image acquisition.

On October 30th, 15 motivated emergency physicians at Western were exposed to a structured 4 hour curriculum on TEE that included:

-didactic lecture and overview of TEE and focused, limited 2D TEE exam protocol
-haptic simulation: inserting TEE probes (using airway mannequins and actual TEE probes)
-image generation simulation: practice generating TEE views on high fidelity simulator
-TEE image review session

Subjectively, the day was a great success  Stay tuned for some more objective metrics regarding its success!

For anybody looking for an excellent, free online resource to better understand TEE and the various views should check out this site.