United States practice patterns in the use of transesophageal echocardiography during adult liver transplantation.
OBJECTIVE
To characterize contemporary practice patterns in the use of transesophageal echocardiography during adult liver transplantation and to identify factors preventing more frequent use.


METHODS
Online questionnaire.


METHODS
Liver transplantation centers in the United States performing 12 or more adult liver transplants in 2011.


METHODS
One representative from each qualifying center: The transplant anesthesiology director, a transplant anesthesiologist personally known to the authors, or the department of anesthesiology chair.


METHODS
Three e-mail attempts were made to solicit participation in the study between June and August 2012.


RESULTS
Of the 97 institutions identified, an anesthesiologist from each of 79 (81.4%) centers completed the questionnaire; 38.0% of centers reported routine use and 57.0% for special circumstances or rescue situations, yielding an overall use rate of 94.9%. This distribution was consistent regardless of operative volume, practice size, or academic affiliation. The sole factor predictive of routine transesophageal echocardiography use was an overlap between an institution's cardiac and transplant anesthesiology teams. In practices not routinely employing the technology, the most compelling reason was a sense that it was not necessary. Although 69.9% of transplant anesthesiologists reportedly were proficient in echocardiography, inadequate anesthesiologist training was also a strongly cited hindrance.


CONCLUSIONS
Transesophageal echocardiography during adult liver transplantation in the United States has become widely prevalent, with notable growth in its use as a routine diagnostic and monitoring modality. Almost all institutions now use the technology at least occasionally, with the participation of cardiac anesthesiologists being predictive of a center's routine use.
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: w-soong@northwestern.edu.
Wayne
W
Soong
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Saadia S
SS
Sherwani
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Michael L
ML
Ault
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Andrew M
AM
Baudo
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Joshua C
JC
Herborn
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Andre M
AM
De Wolf
D001291:Attitude of Health Personnel; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D016343:Monitoring, Intraoperative; D019990:Perioperative Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
clinical practice patterns; intraoperative monitoring; liver transplantation; questionnaires; transesophageal echocardiography