Transesophageal Echo For CRNA's 

Useful as a complementary tool for assessment of etiology of hemodynamic instability in surgical patients. More advanced uses include interventional cardiology such as TAVR, Mitraclip, thrombectomy and amplatz occluding devices. Other uses include guiding interventions for electrophysiology such as atrial septostomy for atrial fibrillation, placement of left atrial appendage occlusion devices (e.g., Watchman) and rescue TEE.  

Contraindications include esophageal pathology and the inability to place the TEE probe without using undue force. Complications include esophageal perforation, dental damage, accidental extubation and oral/lip damage. The most common complication of TEE is misinterpretation.

The most significant utility is ongoing monitoring for cardiac filling, function and ischemia. Other uses include rescue uses for detection of pericardial effusion/tamponade, aortic dissection and pulmonary embolus. 

Basic TEE involves 3-12 views, while advanced utility requires a major step forward from simple interpretation and includes the use of 3D echo and semiquantitative use of Doppler. Advanced and interventional TEE requires a great deal of training and experience along with collaboration across several disciplines including surgical and interventionalist.

In 2026 the in-room provider must have knowledge of transesophageal echocardiography and its role in the procedure. Hands-on learning and perioperative use are the best methods as demonstrated in our study. However there are multiple resources available to at least gain an acceptable level of knowledge of TEE windows, anatomy and utility. The purpose of this website is to offer these resources along with collegial discussion and collaboration.

Basic and rescue TEE are meant for very rudimentary assessment and only complement the clinician's skills as a limited application. A comprehensive and quantitative examination is not within the scope of basic TEE but those performing basic TEE must be able to recognize specific diagnoses. More advanced uses should be performed by an individual with advanced skills acquired through training and experience. In addition, any interventional or advanced use requires knowledge of the surgical procedure or intervention and the role of TEE in decision-making.