The hTEE system for transoesophageal echocardiographic monitoring of haemodynamic instability

Search strategy

In order to maximise sensitivity, the search strategy consisted of only 1 concept: the intervention. The strategy excluded animal studies and non-English language publications. The results were limited to those published since 2008, because this is the year of the first FDA 510k certificate for the device. The final strategy was peer reviewed by an independent information specialist.

The following databases were searched:

The manufacturer's webpages were also searched for published evidence not retrieved by the database searches. The search strategies used for each of the databases are presented below (A1 to A7).

A1. Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R). Ovid SP. 1946 to present. Search date: 4 April 2014.

1 Echocardiography, Transesophageal/is (386)

2 Echocardiography, Transesophageal/ and (Miniaturization/ or Disposable Equipment/) (25)

3 exp Hemodynamics/is (653)

4 (imacor* or htee* or mtee* or htoe* or mtoe* or claritee* or clari-tee* or zura*).ti,ab,kf. (53)

5 ((hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam*) and (transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or tee or toe)).ti,ab,kf. (1784)

6 ((in-dwell* or indwell* or in‑situ or single‑use or disposable or monoplane or mono‑plane or single‑plane or miniature*) adj5 (tee or toe or hemodynam* or haemodynam* or hemo‑dynam* or haemo‑dynam* or transesophag* or trans‑esophag* or transoesophag* or trans‑oesophag*)).ti,ab,kf. (229)

7 or/1-6 (3025)

8 ((in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniature*) adj5 (gaug* or instrument* or measure* or monitor* or sensor* or device*1 or system or systems or probe*1)).ti,ab,kf. (23279)

9 (tee or toe or hemodynam* or haemodynam* or hemo‑dynam* or haemo‑dynam* or transesophag* or trans‑esophag* or transoesophag* or trans‑oesophag* or echo‑cardiograph* or echocardiograph*).ti,ab,kf. (238085)

10 Echocardiography, Transesophageal/ (14921)

11 9 or 10 (242862)

12 8 and 11 (433)

13 7 or 12 (3357)

14 exp animals/ not humans/ (3917953)

15 13 not 14 (2895)

16 limit 15 to (english language and yr="2008 -Current") (601)

A2. Database: Embase. Ovid SP. 1974 to 3 April 2014. Search date: 4 April 2014.

1 (imacor* or htee* or mtee* or htoe* or mtoe* or claritee* or clari-tee* or zura*).ti,ab,kw. (92)

2 ((hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam*) and (transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or tee or toe)).ti,ab,kw. (2535)

3 ((in‑dwell* or indwell* or in‑situ or single‑use or disposable or monoplane or mono‑plane or single‑plane or miniature*) adj5 (tee or toe or hemodynam* or haemodynam* or hemo‑dynam* or haemo‑dynam* or transesophag* or trans‑esophag* or transoesophag* or trans‑oesophag*)).ti,ab,kw. (290)

4 1 or 2 or 3 (2846)

5 ((in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) adj5 (gaug* or instrument* or measure* or monitor* or sensor* or device*1 or system or systems or probe*1)).ti,ab,kw. (26071)

6 (tee or toe or hemodynam* or haemodynam* or hemo‑dynam* or haemo‑dynam* or transesophag* or trans‑esophag* or transoesophag* or trans‑oesophag* or echo‑cardiograph* or echocardiograph*).ti,ab,kw. (319745)

7 *Echocardiography, Transesophageal/ (6322)

8 6 or 7 (320019)

9 5 and 8 (571)

10 4 or 9 (3289)

11 (animal experiment/ or animal model/ or nonhuman/) not human/ (3755217)

12 10 not 11 (2987)

13 limit 12 to (english language and yr="2008 -Current") (1069)

A3. Database: Cochrane Database of Systematic Reviews. The Cochrane Library, Wiley. Issue 4 of 12, April 2014. Search date: 4 April 2014.

#1 MeSH descriptor: [Echocardiography, Transesophageal] explode all trees 363

#2 (imacor* or htee* or mtee* or htoe* or mtoe* or claritee* or clari-tee* or zura*):ti,ab 1

#3 ((hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam*) and (transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or tee or toe)):ti,ab 154

#4 ((in‑dwell* or indwell* or in‑situ or single‑use or disposable or monoplane or mono‑plane or single‑plane or miniatur*) near/5 (tee or toe or hemodynam* or haemodynam* or hemo‑dynam* or haemo‑dynam* or transesophag* or trans‑esophag* or transoesophag* or trans‑oesophag*)):ti,ab 6

#5 #1 or #2 or #3 or #4 456

#6 ((in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (gaug* or instrument* or measur* or monitor* or sensor* or device* or system or systems or probe*)):ti,ab 450

#7 (tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or echo-cardiograph* or echocardiograph*):ti,ab 19878

#8 #6 and #7 24

#9 #8 or #5 475

#10 #9 Publication Date from 2008 to 2014, in Cochrane Reviews (Reviews and Protocols) 1

A4. Database: Database of Abstracts of Reviews of Effect. The Cochrane Library, Wiley. Issue 1 of 4, January 2014. Search date: 4 April 2014.

#1 MeSH descriptor: [Echocardiography, Transesophageal] explode all trees 363

#2 imacor* or htee* or mtee* or htoe* or mtoe* or claritee* or clari-tee* or zura* 116

#3 (hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam*) and (transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or tee or toe) 244

#4 (in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag*) 14

#5 #1 or #2 or #3 or #4 626

#6 (in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (gaug* or instrument* or measur* or monitor* or sensor* or device* or system or systems or probe*) 944

#7 tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or echo-cardiograph* or echocardiograph* 26214

#8 #6 and #7 61

#9 #8 or #5 678

#10 #9 Publication Date from 2008 to 2014, in Other Reviews 8

A5. Database: Cochrane Central Register of Controlled Trials. The Cochrane Library, Wiley. Issue 3 of 12, March 2014. Search date: 4 April 2014.

ID Search Hits

#1 MeSH descriptor: [Echocardiography, Transesophageal] explode all trees 363

#2 imacor* or htee* or mtee* or htoe* or mtoe* or claritee* or clari-tee* or zura* 116

#3 (hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam*) and (transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or tee or toe) 244

#4 (in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag*) 14

#5 #1 or #2 or #3 or #4 626

#6 (in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (gaug* or instrument* or measur* or monitor* or sensor* or device* or system or systems or probe*) 944

#7 tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or echo-cardiograph* or echocardiograph* 26214

#8 #6 and #7 61

#9 #8 or #5 678

#10 #9 Publication Date from 2008 to 2014, in Trials 176

A6. Database: Health Technology Assessment Database. Cochrane Library, Wiley. Issue 1 of 4, January 2014. Search date: 4 April 2014.

#1 MeSH descriptor: [Echocardiography, Transesophageal] explode all trees 363

#2 imacor* or htee* or mtee* or htoe* or mtoe* or claritee* or clari-tee* or zura* 116

#3 (hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam*) and (transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or tee or toe) 244

#4 (in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag*) 14

#5 #1 or #2 or #3 or #4 626

#6 (in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (gaug* or instrument* or measur* or monitor* or sensor* or device* or system or systems or probe*) 944

#7 tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or echo-cardiograph* or echocardiograph* 26214

#8 #6 and #7 61

#9 #8 or #5 678

#10 #9 Publication Date from 2008 to 2014, in Technology Assessments 3

A7. Database: NHS Economic Evaluation Database. Cochrane Library, Wiley. Issue 1 of 4, January 2014. Search date: 4 April 2014.

ID Search Hits

#1 MeSH descriptor: [Echocardiography, Transesophageal] explode all trees 363

#2 imacor* or htee* or mtee* or htoe* or mtoe* or claritee* or clari-tee* or zura* 116

#3 (hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam*) and (transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or tee or toe) 244

#4 (in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag*) 14

#5 #1 or #2 or #3 or #4 626

#6 (in-dwell* or indwell* or in-situ or single-use or disposable or monoplane or mono-plane or single-plane or miniatur*) near/5 (gaug* or instrument* or measur* or monitor* or sensor* or device* or system or systems or probe*) 944

#7 tee or toe or hemodynam* or haemodynam* or hemo-dynam* or haemo-dynam* or transesophag* or trans-esophag* or transoesophag* or trans-oesophag* or echo-cardiograph* or echocardiograph* 26214

#8 #6 and #7 61

#9 #8 or #5 678

#10 #9 Publication Date from 2008 to 2014, in Economic Evaluations 12

Evidence selection

Initial scoping work on the topic, with NICE, informed the inclusion and exclusion criteria for the final evidence selection.

This first sift removed evidence based on the following exclusion criteria:

A total of 1872 records were retrieved from the literature search. After de-duplication, 1367 remained. An initial 409 records were excluded as being animal studies, bench research and irrelevant interventions. The 958 remaining articles were sifted on title and abstract and 942 records were excluded, comprising: conventional transoesophageal echocardiography technologies; populations and settings out of scope (such as intraoperative use in cardiac surgery, hypothermia after cardiac arrest, and measuring haemodynamic effects of weaning off therapies); conference abstracts; and non-original research. Full articles were retrieved for the remaining 16 records.

Full text assessment of the 16 records was done at second sift to identify relevant primary research addressing the use of the medical technology within the defined indication under review (people who are haemodynamically unstable). The conventional evidence hierarchy applies and the best available evidence was selected for inclusion within the evidence tables and for critical appraisal.

During the second sift, 13 records were excluded for the following reasons: 10 were conference abstracts not previously identified from title and abstract; 1 was a general review article; 1 was an initial experience case report with strong likelihood of also being reported in the subsequent case series from the same institution (Maltais et al. 2013); and 1 had a primary outcome concerning training of operators, which was out of the defined scope of this briefing, but contributed to the narrative on training in this briefing (Cioccari et al. 2013).

This left 3 articles on the application of hTEE to transoesophageal echocardiographic monitoring of people who are haemodynamically unstable in the critical care setting, for inclusion within the evidence tables and critical appraisal (1 prospective observational study, 1 case series and 1 case report; tables 1 to 3 respectively).