Insertion of a TEE Probe Using a Video Laryngoscope

Transesophageal echocardiography (TEE) probe placement may appear routine to less experienced healthcare professionals, but those with the greatest expertise are aware of the dire repercussions if it is done incorrectly. Tears of the oropharynx and esophagus are an uncommon but serious complication of TEE insertions that may be caused by trauma. Video laryngoscopy (VL) is one such advancement that has been widely used as a supplement to traditional methods of airway management since the middle of the 2000s.

In a recent publication, researchers compared the safety of VL-guided TEE insertion with that of standard blind placement at five of India's best hospitals for heart surgery.

5 In the 363 patients included in the research, 186 had VL to direct TEE insertion, and 177 had an attempt at blind placement. There were fewer cases of oropharyngeal damage in the VL group compared to the blind placement group (7.5% vs 14.7%, p=0.029). In addition, the VL group had a higher rate of successful TEE probe insertion on the first try (95% vs. 87%, p=0.023). Consideration of VL may be warranted in cardiac surgery patients in light of these statistically significant data showing that it increases first-time success and safety of TEE insertion.

Furthermore, the authors found that the posterior pharyngeal wall was the most prevalent location of damage to the oropharynx due to TEE insertion (57.5% of cases). The significance of this observation stems from the fact that a hematoma or infection in the deep neck regions might be caused by dissection through the posterior pharyngeal wall, so restricting airflow. When doing a blind TEE insertion, it may be difficult to recognize this catastrophic consequence from oropharyngeal trauma; however, VL is a simple way to reduce the likelihood of this happening.

Arytenoid dislocation, vocal cord fracture, and tracheobronchial damage are all possible due to the TEE probe's weight and rigidity. Safe TEE probe insertion may be ensured with the help of VL thanks to the technology's validation of the oro- and esophageal entry anatomy. This is of paramount importance in contexts where there are anatomical variances.

In conclusion, authors showed solid evidence that VL-assisted TEE insertion provides considerable benefits over a blind TEE insertion, such as a 50% decrease in oropharyngeal damage and a 10% improvement in first-attempt TEE probe insertion success. Additionally, VL may provide some safety against unintended TEE airway intubation and damage. In many procedural settings, the necessary equipment for VL already exists, making it a simple and quick option for doctors doing TEE to instantly supplement their practice for the safer treatment of their patients.

Reference –

Borde D, Kumar C, Jasapara A, et al. Use of video laryngoscope to reduce complications of trans esophageal echocardiography probe insertion: A Multicenter Randomized Study. Journal of Cardiothoracic and Vascular Anesthesia 2022.