Development of a Rescue Echocardiography Protocol for Noncardiac Surgery Patients

Genevieve E. Staudt, MD; Kenneth Shelton, MD


Anesth Analg. 2019;129(2):e37-e40. 

In This Article


This study was approved by the Institutional Review Board, and the requirement for written informed consent was waived. Billing data were used to compile a list of all intraoperative TEEs that were performed by RES in noncardiac procedures over a 22-month period from May 1, 2015 to March 31, 2017. Anesthesia care records were reviewed, and patients were classified as undergoing either a rescue or monitoring examination. Only those patients who had a rescue examination performed were included in further data analysis. Medical records, anesthesia care records, and echocardiographic reports were analyzed. Data points collected included demographic data (age at the time of surgery, sex, and ASA classification), surgical information (surgical service and type of surgical procedure), indication for rescue examination, TEE findings, interventions performed, and survival to hospital discharge. Interventions were collected through retrospective review of anesthesia records. Performed interventions were further grouped into either "change in management" or "no change in management." An intervention qualified as a change in management if one of the following criteria was met:

  1. Alteration in medication administration.

  2. Change in fluid management strategy.

  3. New or altered surgical procedure.

  4. Escalation in the level of care, such as intensive care unit admission.