When to use hTEE? Comments on Dr. Christie’s case report.

Author: Harold M. Hastings, PhD, Co-Founder and Chief Technology Officer
Facility: ImaCor Inc. Garden City, NY
Summary: Many of our case reports have described the use of hTEE in the management of serious trauma patients, patients in intensive care following major cardiac surgery, patients with mechanical circulatory support, and similar complex cases. Some readers might ask why we are presenting a general surgery case managed by an internationally recognized trauma surgeon, a case previously presented at the hTEE Trauma Symposium at the 2013 meeting of the Eastern Association for the Surgery of Trauma. First, trauma surgeons are increasingly involved in general surgery. Secondly, even apparently “routine” surgery can require intensive post-surgical management, especially in the context of comorbidities.

hTEE in Trauma: How we are building for the future

Author: Robert Shayn Martin MD
Facility: Wake Forest Baptist Medical Center
Across critical care there has been a trend toward decreased use of cardiovascular data to drive resuscitation. In our ICU
this has led to an increase in the frequency of large volume and vasopressor-based resuscitation without the guidance
of some form of invasive monitoring.

Economics 2013: The Critical Care Dilemma

Author: Rich Lanzillotto, Director of Regulatory Affairs and Quality Assurance
Facility: ImaCor Inc. Garden City, NY
Summary: The treatment of critical care patients is very expensive, accounting for one third of hospital costs. This economic dilemma is somewhat hidden from view as disproportional resources are expended on the minority of patients. The “80/20” rule is clearly in force here.

hTEE Advantages at Vanderbilt University Medical Center

Author: Christopher Hughes MD
Facility: Assistant Professor, Division of Anesthesia/Critical Care, Vanderbilt University Medical Center
Summary: As a result of its distinct advantages for hemodynamic monitoring in the ICU, the Imacor TEE has become an essential tool in the intensivists' armamentarium at Vanderbilt University Medical Center and numerous other academic and VA hospitals nationwide.

Getting started in hTEE-guided hemodynamic assessment and management

Author: Harold M. Hastings, PhD, Co-Founder and Chief Technology Officer
Facility: ImaCor Inc. Garden City, NY
Summary: As Scott Roth, MD, fellow Co-Founder and CMO, would say, there are two key questions: “should I?” and “can I?” Most of my previous columns addressed the question “should I?” based upon case studies and case series by physicians using the ImaCor hTEE system. Here I address the second question “can I?”

TEE in Action: Video Excerpt from the Medical Center of Central Georgia

Author: Benjamin Christie, MD
Facility: Medical Center of Central Georgia
Summary: In this one-minute excerpt of a video presented at the 98th Annual ACS (American College of Surgeons) Clinical Congress, Benjamin Christie MD describes the case of hTEE and its efficacy on a 71-year-old female, status post AAA repair with multiple co-morbidities.

hTEE on the Evening News

Facility: Thomas Jefferson University Hospital
Summary: ABC, NBC & CBS affiliated news channels across the country have reported on the positive impact of using hTEE to care for critically-ill patients, spotlighting the story of this patient at Thomas Jefferson University Hospital (Philadelphia, PA) following a heart attack.

Report from CHEST 2012: Hitoshi Hirose MD Podium Presentation on the Use of hTEE in Weaning ECMO

Author: Harold M. Hastings, PhD, Co-Founder and Chief Technology Officer
Facility: ImaCor Inc. Garden City, NY
Summary: In this column, I report on a podium presentation by Dr. Hitoshi ("Gene") Hirose of Thomas Jefferson University (TJU) Hospital at the recent CHEST meeting in Atlanta. Dr. Hirose's presentation on "ECMO for bridge to decision" addressed the challenge of "Intractable Cardiogenic Shock in the ICU: Transplant, Ventricular Assist Device, or Palliation?" (the title of the session in which he spoke).

Key points:
Extra-corporeal membrane oxygenation (ECMO) provides a useful bridge for many patients with intractable cardiogenic shock; some patients recover completely, others recover RV function but not LV function and can go home on implanted LVAD support, others receive a transplant, and finally, some with no chance at recovery or severe neurological events receive palliative care.
Nobody goes home on ECMO; weaning is essential.
The Thomas Jefferson SCCU team uses an hTEE-guided protocol for weaning ECMO. (emphasis mine)
Finally, we note that the TJU SCCU team has used hTEE more generally in managing VAD as well as ECMO patients - their early experience is reported in Kang CY, Hirose H, Hastings H, Cavarocchi NC. Initial experience with Imacor hTEE-guided management of patients following transplant and mechanical circulatory support. ICU Director 2012;3:230-234. <http://icu.sagepub.com/content/3/5/230.abstract>.

The Top 10 Journal Articles on hTEE (in my humble opinion)

Author: Harold M. Hastings, PhD, Co-Founder and Chief Technology Officer
Facility: ImaCor Inc. Garden City, NY
Summary: Volumes have been written on “Hemodynamic Monitoring Using Echocardiography in the Critically Ill.” In fact, that is the title of a recent book edited by four leaders in the field: Daniel de Backer, Bernard P. Cholley, Michel Slama and Antoine Vieillard-Baron. Since hTEE was developed to take echocardiography from monitoring the critically ill to hemodynamic management of the critically ill guided by on-demand episodic assessment, with expanding use of hTEE in both Europe and the United States, I thought it would be appropriate to list my choices for the top 10 journal articles on hTEE. Here is the list, organized by topic. The first four articles address the hTEE exam.