Pulmonary Artery Catheter Placement by Transesophageal Echocardiography

• Published in: Journal of cardiothoracic and vascular anesthesia 2016
• Main Authors: Cronin, Brett, MD, Robbins, Robin, MD, Maus, Timothy, MD
• Format: Article
• Language: English
• Subjects: Anesthesia & Perioperative Care; Critical Care
• ISSN: 1053-0770
• DOI: 10.1053/j.jvca.2016.07.012

Objective To assess the feasibility of pulmonary artery catheter placement by transesophageal echocardiography inclusive of a description of the technique. Design A prospective, proof of concept study. Setting Single university hospital. Participants Twenty patients with chronic thromboembolic pulmonary hypertension scheduled for pulmonary thromboendarterectomy. Interventions Pulmonary artery catheters were placed in twenty patients solely by transesophageal echocardiographic guidance. Measurements and Main Results Placement of the pulmonary artery catheter in the pulmonary artery with transesophageal echocardiography guidance in under ten minutes was considered successful placement. The time to placement was measured from advancement of the pulmonary artery catheter in the superior vena cava (20 cm) to a final location at the junction of the right pulmonary artery and main pulmonary artery. All twenty pulmonary artery catheters were successfully placed by transesophageal echocardiography guidance and the median time to placement was 43 seconds. In 9 of the 20 cases (45%) the catheter was successfully placed on the first attempt without any adjustments. However, in 9 cases (45%) the catheter required manipulation under TEE vision. In 3 cases (15%) the pulmonary artery catheter was observed to be coiled in the right atrium and in one instance (5%) manipulation of the catheter in the right ventricle was required to enter the outflow tract. Conclusions Transesophageal echocardiography is a viable adjunctive method to conventional pressure waveform placement of pulmonary artery catheters in potentially difficult patients.