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


Intraoperative TEE may be used to rapidly and confidently assess patients who experience hemodynamic instability during noncardiac surgery.[3,5,6] At our institution, we found rescue echocardiography to be a valuable tool in diagnosing pathology and guiding management in a variety of clinical scenarios. Rescue TEE was used in patients of all ages, ASA classifications, and surgical services. Use of rescue TEE was associated with a change in management in 72.9% of cases at our institution. Seventy-five percent of patients survived to hospital discharge, which is slightly lower than the rate found by Shillcutt et al,[7] who demonstrated an 81% survival rate. However, cardiac arrest was a more common indication in our population (22.9% vs 12.9%), possibly contributing to this decreased survival rate. This hypothesis is supported by other studies, such as that by Memtsoudis et al,[6] which demonstrates significantly lower survival rates (32%) in patients who underwent TEE after suffering intraoperative cardiac arrest. We created the Rescue Echo Protocol to further enhance knowledge and utilization of intraoperative TEE as a diagnostic tool. Consistent with this increased educational effort, use of rescue TEE has increased substantially from 14 examinations in the first half of our data collection period to 34 examinations in the second. Our RES provides an easily accessible and valuable tool during noncardiac cases complicated by unexpected or unexplained hemodynamic instability.

The success of an RES is in part reliant on having physicians skilled in echocardiography readily available. We have demonstrated that with the development of a structured protocol with specific guidelines, educational goals, and personnel management, rescue echocardiography may be used to guide management during times of hemodynamic instability in noncardiac surgery.