TEE also has a unique role in cardiac arrest resuscitation due to its ability to interrogate the heart without interrupting chest compressions. This difference in acquisition and image quality has been shown to result in clinically important results with dramatically discordant success rates (97 % for TEE and 38 % for TTE) in answering clinical questions in a critically ill population. Unlike TTE, TEE reliably obtains high-quality images in nearly all circumstances due to the probe’s indwelling esophageal location, millimeters behind the heart. Transesophageal echocardiography (TEE) offers several advantages over TTE in the management of critically ill patients. Despite these important and widely used applications, acquisition of adequate TTE images can be suboptimal in up to 50 % of critically ill patients due to interference from the lungs, mechanical ventilation, surgical dressings, or patient body habitus. Common and accepted applications of TTE by EPs include assessment for hemodynamically significant pericardial effusion, determining prognosis in the setting of cardiac arrest and assessing gross left ventricular (LV) function. As part of this care, EPs frequently employ transthoracic echocardiography (TTE) to assist in diagnosis, therapy, and prognosis. This study has illustrated that EPs can successfully perform this focused TEE protocol after a 4-h workshop with retention of these skills at 6 weeks.Įmergency physicians (EPs) frequently care for critically ill patients with acute circulatory failure or cardiac arrest. Twelve participants engaged in a 6-week retention assessment, which revealed acceptable images and inter-rater agreement as follows: mid-esophageal four-chamber, 12 (100 % k = 0.92) mid-esophageal long axis, 12 (100 %, k = 0.67) transgastric short-axis, 11 (91.7 %, k = 1.0) and bicaval view, 11 (91.7 %, k = 1.0). ![]() Eleven (78.6 %, k = 1.0) participants were able to successfully obtain an acceptable transgastric short-axis view, and 11 (78.6 %, k = 1.0) EPs successfully obtained a bicaval view. Immediately following the seminar, 14 (100 % k = 1.0) and 10 (71.4 %, k = 0.65) successfully obtained an acceptable mid-esophageal four-chamber and mid-esophageal long-axis view. Resultsįourteen EPs participated in this study. A 6-week follow-up session assessed skill retention. Following the training, participants engaged in an assessment of their abilities to carry out a focused TEE on a high-fidelity simulator. ![]() The seminar emphasized TEE principles and views obtained from four vantage points. MethodsĪcademic EPs were invited to participate in a 4-h didactic and simulation-based workshop. This study aims to develop a focused TEE examination tailored for the ED and to evaluate TEE skill acquisition and retention by TEE-naïve EPs following a focused 4-h curriculum. Despite these advantages, use of TEE by emergency physicians (EPs) remains rare, as no focused TEE protocol for emergency department (ED) use has been defined nor have methods of training been described. Transesophageal echocardiography (TEE) offers several advantages over transthoracic echocardiography (TTE).
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