ADVANTAGES AND LIMITATIONS
Many advantages exist to this novel technique. First, this can avoid mechanical ventilation in patients who can potentially be managed with conscious sedation that can save resources for the hospital. Moreover, these patients could potentially have issues with general anasethsia (side effects of medications and hemodynamic instability in the presence of large PEs and RV strain) and mechanical ventilation and perhaps would be better to avoid. Second, it does not require the presence of another cardiologist to perform TEE.
ICE from the arm could be challenging to interpret because it will be inverted. One way to go around that is to use the “invert” button on the echo machine. Operators familiar with ICE should have no problem with performing and correctly interpreting ICE from the arm. Closure of the 10 Fr basilic vein access could theoretically be an issue; however, we have closed both patients with pressure dressing and a co-band without any complications.