Videolaryngoscopy for transesophageal echocardiography probe insertion: a systematic review and meta-analysis of randomized controlled trials

Abstract

Transesophageal echocardiography (TEE) is a well-established procedure, but serious complications may occur. This systematic review and meta-analysis assessed the utility of videolaryngoscopy-assisted technique in TEE probe insertion. We performed a systematic search in MEDLINE, EMBASE, CENTRAL, and ICTRP. We included RCTs comparing TEE probe insertion techniques assisted with videolaryngoscopy and with any other insertion technique in adult patients. Primary outcome measures were (1) the number of attempts before successful TEE probe insertion, and (2) the risk of any procedural injury to related structures. The secondary outcome measure was time to TEE probe insertion. In total, three studies (n = 266) were included in this systematic review. Overall, a significantly less number of attempts were required with videolaryngoscopy-assisted insertion (mean difference [MD] − 0.60; 95% confidence interval [CI] − 0.73, − 0.46; low quality of evidence). Videolaryngoscopy-assisted technique was also associated with smaller risk of complications (risk ratio [RR] 0.17; 95% CI 0.05, 0.62; low quality of evidence). There was no significant difference in time to probe insertion (MD − 8.57; 95% CI − 26.31, 9.16; very low quality of evidence). The use of videolaryngoscopy for TEE probe insertion is associated with a significant reduction in the number of attempts and complication rate.

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References

  1. 1.

    Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, Picard MH. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26:921–64.

    Article  Google Scholar 

  2. 2.

    Mayo PH, Narasimhan M, Koenig S. Critical care transesophageal echocardiography. Chest. 2015;148:1323–32.

    Article  Google Scholar 

  3. 3.

    Daniel WG, Erbel R, Kasper W, Visser CA, Engberding R, Sutherland GR, Grube E, Hanrath P, Maisch B, Dennig K. Safety of transesophageal echocardiography: a multicenter survey of 10,419 examinations. Circulation. 1991;83:817–21.

    CAS  Article  Google Scholar 

  4. 4.

    Kallmeyer IJ, Collard CD, Fox JA, Body SC, Shernan SK. The safety of intraoperative transesophageal echocardiography: a case series of 7200 cardiac surgical patients. Anesth Analg. 2001;92:1126–30.

    CAS  Article  Google Scholar 

  5. 5.

    Lennon MJ, Gibbs NM, Weightman WM, Leber J, Ee HC, Yusoff IF. Transesophageal echocardiography-related gastrointestinal complications in cardiac surgical patients. J Cardiothorac Vasc Anesth. 2005;19:141–5.

    Article  Google Scholar 

  6. 6.

    Huang CH, Lu CW, Lin TY, Cheng YJ, Wang MJ. Complications of intraoperative transesophageal echocardiography in adult cardiac surgical patients—experience of two institutions in Taiwan. J Formos Med Assoc. 2007;106:92–5.

    Article  Google Scholar 

  7. 7.

    Piercy M, McNicol L, Dinh DT, Story DA, Smith JA. Major complications related to the use of transesophageal echocardiography in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23:62–5.

    Article  Google Scholar 

  8. 8.

    Ramalingam G, Choi SW, Agarwal S, Kunst G, Gill R, Fletcher SN, Klein AA. Complications related to peri-operative transoesophageal echocardiography: a one-year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care. Anaesthesia. 2019;75(1):21–6.

    Article  Google Scholar 

  9. 9.

    Na S, Kim CS, Kim JY, Cho JS, Kim KJ. Rigid laryngoscope-assisted insertion of transesophageal echocardiography probe reduces oropharyngeal mucosal injury in anesthetized patients. Anesthesiology. 2009;110:38–40.

    Article  Google Scholar 

  10. 10.

    Min JK, Spencer KT, Furlong KT, DeCara JM, Sugeng L, Ward RP, Lang RM. Clinical features of complications from transesophageal echocardiography: a single-center case series of 10,000 consecutive examinations. J Am Soc Echocardiogr. 2005;18:925–9.

    Article  Google Scholar 

  11. 11.

    Chang JE, Min SW, Kim CS, Lee JM, No H, Hwang JY. Effect of jaw thrust on transesophageal echocardiography probe insertion and concomitant oropharyngeal injury. J Cardiothorac Vasc Anesth. 2015;29:1266–71.

    Article  Google Scholar 

  12. 12.

    Sinha PK, Koshy T. Reverse Sellick's Maneuver for transesophageal echocardiographic probe placement. J Cardiothorac Vasc Anesth. 2007;21:626–8.

    Article  Google Scholar 

  13. 13.

    Hirabayashi Y, Okada O, Seo N. Airtraq laryngoscope for the insertion of a transesophageal echocardiography probe. J Cardiothorac Vasc Anesth. 2008;22:331–2.

    Article  Google Scholar 

  14. 14.

    Huang S, Hua FZ, Xu GH. GlideScope-assisted insertion of a transesophageal echocardiography probe. J Cardiothorac Vasc Anesth. 2017;31:e51.

    Article  Google Scholar 

  15. 15.

    Kim MK, Park SW, Sim Y, Lee JW. Use of a McGrath videolaryngoscope to assist transesophageal echocardiography probe insertion in anesthetized patients. J Cardiothorac Vasc Anesth. 2015;29:e16–e1717.

    Article  Google Scholar 

  16. 16.

    Berkow LC, Morey TE, Urdaneta F. The technology of video laryngoscopy. Anesth Analg. 2018;126:1527–34.

    Article  Google Scholar 

  17. 17.

    Ishida T, Kiuchi C, Sekiguchi T, Tsujimoto T, Kawamata M. McGRATH MAC video laryngoscope for insertion of a transoesophageal echocardiography probe: a randomised controlled trial. Eur J Anaesthesiol. 2016;33:263–8.

    Article  Google Scholar 

  18. 18.

    Kavrut ON, Kavakli A. Use of McGrath MAC videolaryngoscope to assist transesophageal echocardiography probe insertion in intubated patients. J Cardiothorac Vasc Anesth. 2017;31:191–6.

    Article  Google Scholar 

  19. 19.

    Kimura T, Katoh T, Ogasawara T, Mimuro S, Makino H, Suzuki A, Sato S. The McGRATH MAC video laryngoscope facilitates probe insertion during transesophageal echocardiography. Masui. 2016;65:68–74.

    PubMed  Google Scholar 

  20. 20.

    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  Google Scholar 

  21. 21.

    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:5928.

    Article  Google Scholar 

  22. 22.

    Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schunemann HJ. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383–94.

    Article  Google Scholar 

  23. 23.

    Aviv JE, Di Tullio MR, Homma S, Storper IS, Zschommler A, Ma G, Petkova E, Murphy M, Desloge R, Shaw G, Benjamin S, Corwin S. Hypopharyngeal perforation near-miss during transesophageal echocardiography. Laryngoscope. 2004;114:821–6.

    Article  Google Scholar 

  24. 24.

    Bavalia N, Anis A, Benz M, Maldjian P, Bolanowski PJ, Saric M. Esophageal perforation, the most feared complication of TEE: early recognition by multimodality imaging. Echocardiography. 2011;28:E56–E5959.

    Article  Google Scholar 

  25. 25.

    Spahn DR, Schmid S, Carrel T, Pasch T, Schmid ER. Hypopharynx perforation by a transesophageal echocardiography probe. Anesthesiology. 1995;82:581–3.

    CAS  Article  Google Scholar 

  26. 26.

    Zaouter C, Calderon J, Hemmerling TM. Videolaryngoscopy as a new standard of care. Br J Anaesth. 2015;114:181–3.

    CAS  Article  Google Scholar 

  27. 27.

    Paolini JB, Donati F, Drolet P. Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Can J Anaesth. 2013;60(2):184–91.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Tetsuro Kimura, MD, PhD, Department of Anesthesiology and Intensive Care, Hamamatsu University of School of Medicine, Hamamatsu, Japan, for providing unpublished data. The authors would like to thank Mr. Paul Williams, Kurashiki Central Hospital, Japan, for English language editing.

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MN: This author helped in the study design, conduct study, data collection, data analysis, and manuscript preparation. YT: This author helped in the study design, conduct study, data collection, data analysis, and manuscript preparation. MB: This author helped in the study design, data analysis, and manuscript preparation. YK: This author helped in the study design, conduct study, data analysis, and manuscript preparation. HT: This author helped in the study design, data analysis, and manuscript preparation. YI: This author helped in the study design, data analysis, and manuscript preparation. TF: This author helped in the study design, conduct study, data collection, data analysis, and manuscript preparation.

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Correspondence to Motoki Namekawa.

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Appendix: Search strategy. Supplementary file1 (DOCX 12 kb)

Supplemental Figure 1: Forest plot showing comparison of number of attempts with fixed effect model. Supplementary file2 (JPG 179 kb)

Supplemental Figure 2: Forest plot showing comparison of complications rate with fixed effect model. Supplementary file3 (JPG 292 kb)

Supplemental Figure 3: Subgroup analysis (time to probe insertion) by the control type. Supplementary file4 (JPG 478 kb)

Supplemental Figure 4: Forest plot showing comparison of number of attempts with four randomized controlled trials. Supplementary file5 (JPG 322 kb)

Supplemental Figure 5: Forest plot showing comparison of complication rate with four randomized controlled trials. Supplementary file6 (JPG 211 kb)

Supplemental Figure 6: Forest plot showing comparison of time to probe insertion with four randomized controlled trials. Supplementary file7 (JPG 331 kb)

Supplemental Table 1: PRISMA checklist. Supplementary file8 (DOCX 23 kb)

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Namekawa, M., Tsujimoto, Y., Banno, M. et al. Videolaryngoscopy for transesophageal echocardiography probe insertion: a systematic review and meta-analysis of randomized controlled trials. J Anesth 34, 453–463 (2020). https://doi.org/10.1007/s00540-020-02759-x

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Keywords

  • Transesophageal echocardiography
  • Probe insertion
  • Videolaryngoscopy
  • Systematic review
  • Meta-analysis
  • Randomized controlled trial