Audit of anaesthetist-performed echocardiography on perioperative management decisions for non-cardiac surgery

Abstract

Intraoperative transoesophageal echocardiography is increasingly used for guiding intraoperative management decisions during non-cardiac surgery. Transthoracic echocardiography (TTE) equipment and training is becoming more available to anaesthetists, and its point-of-care application may facilitate real-time haemodynamic management and preoperative screening. We conducted an audit of transthoracic and transoesophageal echocardiograms, performed by an anaesthetist at a tertiary referral centre over a 9-month period, to identify the effect of echocardiography on clinical decision-making in patients undergoing non-cardiac surgery. The indications for echocardiography followed published guidelines. Echocardiographic examinations of 97 patients included 87 transthoracic, and 14 transoesophageal studies. Of 36 studies conducted in the preoperative clinic, eight revealed significant cardiac pathology, necessitating cardiology referral or admission before surgery. Preoperative transthoracic echocardiograms performed on the day of surgery (n=39) led to two cancellations of surgery owing to end-stage cardiac disease, the institution of two unplanned surgical procedures (drainage of pleural and pericardial effusions), and to significant changes in anaesthetic and haemodynamic management, or both in 18 patients. Greater influence on management occurred with emergency surgery (75%) than elective surgery (43%). Intraoperative transthoracic (n=10) and transoesophageal (n=14) echocardiography also altered management (altered surgery in two patients, cancellation in one, and altered haemodynamic management in 18 patients). Anaesthetist-performed point-of-care TTE and thoracic ultrasound may have a high clinical impact on the perioperative management of patients scheduled for non-cardiac surgery.