title: A systematic review of transthoracic and transesophageal echocardiography in non-cardiac surgery: implications for point-of-care ultrasound education in the operating room.
abstract: OBJECTIVE
  Point-of-care ultrasound (POCU) is an evolving field in anesthesia. Therefore a systematic review of common diagnoses made by POCU during non-cardiac surgery was conducted. The information obtained from the review may be used to develop POCU curricula for the perioperative setting during non-cardiac surgery.
  
  
  METHODS
  A systematic review was conducted for perioperative use of transthoracic /transesophageal echocardiography (TTE/TEE) in high-risk patients or in other patients experiencing periods of hemodynamic instability. The diagnoses included segmental wall motion abnormalities (SWMAs), low left ventricular ejection fraction (LVEF), hypovolemia, air embolism, cardiac/aortic thrombus, pulmonary embolus (PE), aortic valve disease, mitral valve disease, tricuspid valve disease, right ventricular (RV) failure, pericardial disease, and patent foramen ovale.
  
  
  RESULTS
  Three hundred twenty-one studies were found using our search terms, and thirteen studies were retained that met our inclusion criteria for review. The studies included 968 patients analyzed as either preoperative exams in high-risk patients (n = 568) or intraoperative exams during times of hemodynamic compromise/cardiac arrest (n = 400). The most common diagnoses in the preoperative exam group were low ejection fraction (25.4%), aortic valve disease (24.4%), mitral valve disease (20.0%), RV failure (6.6%), and hypovolemia (6.3%). In the intraoperative exam group, the most common diagnoses were hypovolemia (33.2%), low ejection fraction (20.5%), RV failure (13.1%), SWMAs (10.1%), and PE (5.8%).
  
  
  CONCLUSIONS
  In this systematic review examining the use of TTE or TEE in non-cardiac surgery, the most frequent diagnoses were valvulopathy, low LVEF, hypovolemia, PE, SWMAs, and RV failure. This information should be used to inform evidence-based curricula for POCU in anesthesiology.
authors.affiliation: Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada. Amandajasudavisius@gmail.com.
authors.forename: Amanda
authors.initials: A
authors.lastname: Jasudavisius
authors.affiliation: Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Arellano
authors.affiliation: Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Martin
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Western University, London, ON, Canada.
authors.forename: Brie
authors.initials: B
authors.lastname: McConnell
authors.affiliation: Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada. Daniel.bainbridge@lhsc.on.ca.|Department of Anesthesiology and Perioperative Medicine, Western University, London, ON, Canada. Daniel.bainbridge@lhsc.on.ca.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bainbridge
mesh_terms: D000776:Anesthesiology / Q000193:education*; D003479:Curriculum; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D006801:Humans; D009873:Operating Rooms; D019095:Point-of-Care Systems; D013514:Surgical Procedures, Operative