Transoesophageal Echocardiogram Use and Safety: A 12-Month Audit at a Tertiary Centre

Abstract

Background: Transoesophageal echocardiography (TOE) is an invaluable tool in assessment of intracardiac structures; we audited the use of TOE in our hospital to establish the indications, safety, and characteristics for TOEs over a 1-year period. Transoesophageal echocardiography at our centre is generally performed by registrars under the supervision of a cardiologist in a variety of locations, including the intensive care unit, cardiac care unit, general wards, and the catheterisation laboratory. Intravenous sedation with midazolam and fentanyl is routinely used unless contraindicated. Method: Transoesophageal echocardiography procedures performed from January 2018 to December 2018 inclusive were identified form our EchoPAC database and reviewed. Results: A total of 216 TOEs were performed, of which 75% were inpatient studies. The majority (57%) of TOEs were performed for a cardiology department, followed by internal medicine (25%) then neurology (8%). Suspected endocarditis was the most frequent indication for inpatient studies (52%). Native valve and atrial septal defect assessments were the most frequent outpatient indications (62% and 45%, respectively). Other inpatient indications included left atrial appendage assessment (19%) and intraprocedural use (12%). Three-dimensional image datasets were acquired in 80% of cases. A cardiologist's report was available in 76% of cases and a provisional report in 15%. A single case of apnoea occurred requiring sedation reversal and a single case where atrial flutter occurred. Conclusion: Transoesophageal echocardiography under conscious sedation with midazolam and fentanyl is safe in a variety of environments, with an overall complication rate of <1%. Suspected endocarditis is the most common indication for inpatient TOEs and native valvular assessment for outpatient TOEs.