Rescue transesophageal echocardiography: Approach and future

Rescue transesophgeal echocardiography (TEE) is used in the peri-operative setting and intensive care units mainly as a tool for diagnosing events that may potentially be addressed in patients with hemodynamic instability of unclear origin and with no contraindications for its use.TEE is indicated in those cases in which the acoustic window in transthoracic echocardiography is poor or it is impossible to access the chest, in patients with undifferentiated shock but a high suspicion of cardiovascular origin, or in extreme hemodynamic collapse, namely cardiorespiratory arrest.It must be performed by trained personnel after making sure that there are no contraindications for the insertion of the transesophageal probe, or when the benefit is greater that the risks, considering that TEE-associated morbidity reported by various authors is between 0.2% and 1.2%. 1 There are no reports in the literature of the mortality rate associated with complications derived from the use of TEE. 1 The usefulness and benefit of using TEE in different clinical settings is well proven in patients taken to cardiac surgery, but its application as a rescue tool in patients taken to non-cardiac surgery has been less studied. [2][3]][4] In 2013, the American Society of Echocardiographers (ASE) together with the Society of Cardiovascular Anesthesiologists (SCA) published an expert consensus recommending the use of TEE to assess hemodynamic instability in the perioperative period, taking into consideration that hypovolemia