COVID-19 guidance | Provision of TOE

In light of our evolving understanding of the COVID-19 pandemic, and in particular response to recent communication from the British Laryngological Association1, the British Society of Echocardiography has produced updated clinical guidance regarding trans-oesophageal echocardiography (TOE).

Performing TOE necessitates exposure to aerosolised secretion and accordingly carries an increased risk of COVID-19 transmission. In addition, the symptom profile of COVID-19 is imprecise and heterogenous; making it hard to assess who is currently a vector. Lastly it is assumed that COVID-19 is now widespread in the UK.

The Society therefore now recommends the following:

  1. All routine TOE cases should be cancelled
  2. For cases where it is still felt that a TOE will have a significant and immediate impact on patient management, clarification with other key MDT members should be undertaken first (e.g. liaising with surgical colleagues to ensure that an operation remains possible if indicated or with microbiology colleagues to discuss potential treatment strategies for the management of infective endocarditis)
  3. Perioperative TOE should be performed only if there is a favourable risk:benefit ratio whilst taking into account the added risk of COVID-19 transmission. The added airway protection provided by a cuffed endotracheal tube and closed circuit ought to reduce the risk of aerosol generation in an anaesthetised, paralysed and ventilated patient. However, the longer duration and exposure to airway secretions may increase infection risk. Care must be taken to avoid accidental extubation and disconnection of the anaesthetic circuit
  4. Full personal protective equipment should be worn by all operators and assistants for all TOE examinations, including the use of an appropriate fit tested mask
  5. Appropriate decontamination of the procedure room and equipment should be undertaken after each procedure

It is clear that the coming weeks will be very demanding for all healthcare professionals; please look out for each other and stay safe. Anyone who feels able to please share your learning points and experiences using the COVID-19 community on our website.

  • Tom Ingram - Consultant Cardiologist
  • Dan Augustine - Consultant Cardiologist
  • Claire Colebourn - Consultant Medical Intensivist
  • Keith Pearce - Consultant Cardiac Physiologist
  • Sandeep Hothi - Consultant Cardiologist
  • Mahesh Prabhu - Consultant Cardiothoracic Anaesthetist


  1. Message from the BLA President