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Videolaryngoscopy for transesophageal echocardiography probe insertion: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Transesophageal echocardiography (TEE) is a well-established procedure, but serious complications may occur. This systematic review and meta-analysis assessed the utility of videolaryngoscopy-assisted technique in TEE probe insertion. We performed a systematic search in MEDLINE, EMBASE, CENTRAL, and ICTRP. We included RCTs comparing TEE probe insertion techniques assisted with videolaryngoscopy and with any other insertion technique in adult patients. Primary outcome measures were (1) the number of attempts before successful TEE probe insertion, and (2) the risk of any procedural injury to related structures. The secondary outcome measure was time to TEE probe insertion. In total, three studies (n = 266) were included in this systematic review. Overall, a significantly less number of attempts were required with videolaryngoscopy-assisted insertion (mean difference [MD] − 0.60; 95% confidence interval [CI] − 0.73, − 0.46; low quality of evidence). Videolaryngoscopy-assisted technique was also associated with smaller risk of complications (risk ratio [RR] 0.17; 95% CI 0.05, 0.62; low quality of evidence). There was no significant difference in time to probe insertion (MD − 8.57; 95% CI − 26.31, 9.16; very low quality of evidence). The use of videolaryngoscopy for TEE probe insertion is associated with a significant reduction in the number of attempts and complication rate.

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Acknowledgements

The authors would like to thank Tetsuro Kimura, MD, PhD, Department of Anesthesiology and Intensive Care, Hamamatsu University of School of Medicine, Hamamatsu, Japan, for providing unpublished data. The authors would like to thank Mr. Paul Williams, Kurashiki Central Hospital, Japan, for English language editing.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan

    Motoki Namekawa

  2. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Yasushi Tsujimoto

  3. Department of Nephrology and Dialysis, Kyoritsu Hospital, Hyogo, Japan

    Yasushi Tsujimoto

  4. Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan

    Masahiro Banno

  5. Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Masahiro Banno

  6. Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan

    Yuki Kataoka & Hiraku Tsujimoto

  7. Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Kurashiki, Japan

    Yu Inaba

  8. Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan

    Takashi Fujiwara

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  1. Motoki Namekawa
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  2. Yasushi Tsujimoto
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  3. Masahiro Banno
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  4. Yuki Kataoka
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  5. Hiraku Tsujimoto
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Contributions

MN: This author helped in the study design, conduct study, data collection, data analysis, and manuscript preparation. YT: This author helped in the study design, conduct study, data collection, data analysis, and manuscript preparation. MB: This author helped in the study design, data analysis, and manuscript preparation. YK: This author helped in the study design, conduct study, data analysis, and manuscript preparation. HT: This author helped in the study design, data analysis, and manuscript preparation. YI: This author helped in the study design, data analysis, and manuscript preparation. TF: This author helped in the study design, conduct study, data collection, data analysis, and manuscript preparation.

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Correspondence to Motoki Namekawa.

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Appendix: Search strategy. Supplementary file1 (DOCX 12 kb)

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Supplemental Figure 1: Forest plot showing comparison of number of attempts with fixed effect model. Supplementary file2 (JPG 179 kb)

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Supplemental Figure 2: Forest plot showing comparison of complications rate with fixed effect model. Supplementary file3 (JPG 292 kb)

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Supplemental Figure 3: Subgroup analysis (time to probe insertion) by the control type. Supplementary file4 (JPG 478 kb)

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Supplemental Figure 4: Forest plot showing comparison of number of attempts with four randomized controlled trials. Supplementary file5 (JPG 322 kb)

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Supplemental Figure 5: Forest plot showing comparison of complication rate with four randomized controlled trials. Supplementary file6 (JPG 211 kb)

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Supplemental Figure 6: Forest plot showing comparison of time to probe insertion with four randomized controlled trials. Supplementary file7 (JPG 331 kb)

Supplemental Table 1: PRISMA checklist. Supplementary file8 (DOCX 23 kb)

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Namekawa, M., Tsujimoto, Y., Banno, M. et al. Videolaryngoscopy for transesophageal echocardiography probe insertion: a systematic review and meta-analysis of randomized controlled trials. J Anesth 34, 453–463 (2020). https://doi.org/10.1007/s00540-020-02759-x

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  • DOI: https://doi.org/10.1007/s00540-020-02759-x

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