Hemodynamic TEE Management Estimates Fluid Responsiveness in a Post Cardiac Surgery Patient

Author: Chad E. Wagner MDand Will Costello MD
Facility: Vanderbilt University Medical Center, Nashville, TN
Summary: This case report describes the use of a miniaturized, disposable transesophageal echo probe (ClariTEE®, ImaCor Inc., Garden City, NY) to diagnose and monitor hemodynamic instability in a patient following surgery for aortic valve
replacement and CABG X 3. Hemodynamic TEE (hTEE™) management allowed the physician to gauge fluid responsiveness in this patient with a moderately reduced EF of 30-35% preeoperatively, CAD and COPD. hTEE also allowed the physician to follow the formation of a thrombus. This thrombus eventually became hemodynamically significant and the high chest tube output led to a return to the OR with removal of the clot accomplished and bleeding addressed.

hTEE Integrated Into Unit Protocols

Facility: University of Alabama at Birmingham
Summary: Wake Forest, UAB, Columbia and TJU are among the hospitals that have incorporated hTEE into their post-op cardiac and/or trauma patient protocols. The following is an example of one such protocol, developed and used at UAB's Trauma/Burn ICU.

hTEE Use in the Neuro ICU

Author: Dr. Jacqueline Urtecho
Facility: Thomas Jefferson University Hospital, Neuro ICU
Summary: "The biggest advantage to implementing hTEE for a Neuro ICU is ease of use and quickness of evaluation for volume..." hTEE is now helping physicians globally wean neuro ICU patients off pressors faster and manage their unique hemodynamic complexities.

Pressors – yes or no? How hTEE can help

Author: Harold M. Hastings, PhD, Co-Founder and Chief Technology Officer
Facility: ImaCor Inc. Garden City, NY
Summary: A recent 2,332 patient study from Harvard-MIT, Mount Sinai, Beth Deaconess and NYU (Lee J, Kothari R, Ladapo JA, Scott DJ, Celi LA. Interrogating a clinical database to study treatment of hypotension in the critically ill. BMJ Open. 2012) may help you better understand the role of and their side effects. We present here the high points of that study, a link to the study and abstract, and some thoughts about the role of hTEE.

The soul of our new machine: the Zura EVO

Author: Harold M. Hastings, PhD, Co-Founder and Chief Technology Officer
Facility: ImaCor Inc. Garden City, NY
Summary: With the first US and European installs of ImaCor’s new Zura EVO, I am using this column to briefly reflect on its evolution. On one level, the Zura EVO consists of ultrasound and computer hardware, computer software, a user interface, a stand, etc. But on a deeper level, the Zura EVO is intended to reflect what our customers need to better treat their patients. On this level, the Zura EVO consists of the knowledge, passion, and hard work of a large team, including you, the users and readers. However, I will not go into philosophy, but rather into how your past, present and future commitment to patient care led us to develop the Zura EVO. (The title is based on Tracy Kidder’s Pulitzer and National Book Award winner, “The Soul of a New Machine.”)

hTEE = On Demand When You Need It, In For the Long Haul

Author: Harold M. Hastings, PhD and Chief Technology Officer
Facility: ImaCor Inc.
Summary: It is now four years since our first post-clearance evaluation session with Dr. Jesse Marymont of North Shore University Hospital in Evanston, IL. At that time, we were getting set up for a routine hTEE case with another physician there, when Dr. Marymont asked us to rush down to the PACU to help him identify the cause of hemodynamic instability: a 48 kg female patient had become hemodynamically unstable post spinal surgery (systolic BP 70-80 mmHg and falling despite a positive fluid balance of 3.4 L and significant pressor support). After placing an hTEE probe, Dr. Marymont diagnosed the cause of the patient’s instability as hypovolemic shock, and administered additional fluids stat. Dr. Marymount continued to use hTEE to help manage fluids and vasoactive support, stabilizing the patient the following morning (systolic BP 140 mmHg, no pressor support).

New Technology Assessment — Controlling Uncertainty

Author: Rich Lanzillotto, Director of Regulatory Affairs and Quality Assurance
Facility: ImaCor Inc.
Summary: When new technologies are proposed to improve patient outcomes and reduce costs, hospitals seek to control the uncertainty of the new technology. Risk arises from this uncertainty which includes the effect the new technology will have on patient outcomes and the effect it will have on the hospital’s budget. This article describes ImaCor’s new technology assessment (NTA) procedure for its critical care hTEE technology and recommends it is a model that addresses the various uncertainties.

The Efficacy of Miniaturized TEE Imaging in the Management of a Patient S/P CABG with Hypotension and RV Failure

Author: Nicholas Cavarrocchi MD, Christopher Kang MD
Facility: Thomas Jefferson University Hospital, Philadelphia PA
Summary: A 75 year-old male with low LV ejection fraction and severe CAD developed hypotension requiring an IABP before CABG. The patient had low CI (1.81 l/min/m2) post-operatively on epinephrine, milrinone, neosynephrine, and amiodarone; an EKG showed new atrial fibrillation and changes consistent with inferior wall infarction. Acute right heart failure was detected with a miniaturized 72 hour TEE probe designed for hemodynamic management in the ICU (ClariTEE, ImaCor Inc, Garden City, NY), and managed by weaning off epinephrine, increasing fluids and inodilators (milrinone) under hTEE guidance. Cardiac index improved to 2.8 l/min/m2 and bi-ventricular function became normal over 72 hours under further ClariTEE imaging-guided management.

hTEE - A Nursing Perspective, with Rebecca Stamm

Author: Rebecca Stamm MSN, RN, CCNS, WCC, CCRN
Facility: Hospital of the University of Pennsylvania, Philadelphia, PA
Summary: Rebecca Stamm MSN, RN, CCNS, WCC, CCRN shares her perspective on hTEE as a treatment option for complex patients in the cardiac surgery intensive care unit at the Hospital of the University of Pennsylvania.

Managing RV Dysfunction With hTEE: A Review of User Experience

Author: Harold M. Hastings, PhD and Chief Technology Officer
Facility: ImaCor Inc.
Summary: Many studies have found transesophageal echocardiography (TEE) to have a significant clinical impact. One significant reason is the unique ability of TEE to assess right ventricular function, important in pulmonary perfusion and in generating adequate preload for the left ventricle, compared with limitations of indirect monitors.