Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic

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. A multi-disciplinary group of experts in point-of-care echocardiography and TEE representing intensive care, critical care cardiology and emergency medicine from the United States and Canada, convened to review the available evidence, share experiences, and produce a consensus statement aimed to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering TEE in critically ill patients during the COVID-19 pandemic. While transthoracic echocardiography (TTE) can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. Among other critical care applications, TEE can allow hemodynamic assessment of patients during prone ventilation, perform serial evaluations of the lungs during recruitment maneuvers, guide cardiac arrest resuscitation, and facilitate veno-venous extra corporeal membrane oxygenation (VV-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, equipment required before, during, and after an examination. 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.
Highlights • Diagnostic procedures and tools that promote efficiency and accuracy in care should be appropriately utilized during the COVID-19 pandemic. • TEE offers those caring for intubated critically-ill patients a high-quality imaging modality capable of answering goal-directed questions that can impact decision making at the bedside. • TEE can be useful during the pandemic when adequate TTE windows cannot be obtained, when there is need to address hemodynamic instability during prone ventilation, to perform serial evaluations of the lungs, during cardiac arrest resuscitation and to guide veno-venous ECMO cannulation. • Despite plausibility as an aerosol generating procedure, based on the available evidence and experience in the frontlines our group of interdisciplinary experts from across North America support the use of TEE as an invaluable tool for managing the critically ill patient with COVID-19.