TY - JOUR
T1 - Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice
AU - Reardon, Robert F.
AU - Chinn, Elliott
AU - Plummer, Dave
AU - Laudenbach, Andrew
AU - Rowland Fisher, Andie
AU - Smoot, Will
AU - Lee, Daniel
AU - Novik, Joseph
AU - Wagner, Barrett
AU - Kaczmarczyk, Chris
AU - Moore, Johanna
AU - Thompson, Emily
AU - Tschautscher, Craig
AU - Dunphy, Teresa
AU - Pahl, Thomas
AU - Puskarich, Michael A.
AU - Miner, James R.
N1 - Publisher Copyright:
© 2021 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.
PY - 2022/3
Y1 - 2022/3
N2 - Introduction: Transthoracic echocardiography (TTE) is a standard procedure for emergency physicians (EPs). Transesophageal echocardiography (TEE) is known to have great utility in patients who are critically ill or in cardiac arrest and has been used by some EPs with specialized ultrasound (US) training, but it is generally considered outside the reach of the majority of EPs. We surmised that all of our EPs could learn to perform focused TEE (F-TEE), so we trained and credentialed all of the physicians in our group. Methods: We trained 52 EPs to perform and interpret F-TEEs using a 4-h simulator-based course. We kept a database of all F-TEE examinations for quality assurance and continuous quality feedback. Data are reported using descriptive statistics. Results: Emergency physicians attempted 557 total F-TEE examinations (median = 10, interquartile range = 5–15) during the 42-month period following training. Clinically relevant images were obtained in 99% of patients. EPs without fellowship or other advanced US training performed the majority of F-TEEs (417, 74.9%) and 94.3% (95% confidence interval [CI] = 91.4%–96.3%) had interpretable images recorded. When TTE and TEE were both performed (n = 410), image quality of TEE was superior in 378 (93.3%, 95% CI = 89.7%–95%). Indications for F-TEE included periarrest states (55.7%), cardiac arrest (32.1%), and shock (12.2%). There was one case of endotracheal tube dislodgement during TEE placement, but this was immediately identified and replaced without complication. Conclusion: After initiating a mandatory group F-TEE training and credentialing program, we report the largest series to date of EP-performed resuscitative F-TEE. The majority of F-TEE examinations (75%) were performed by EPs without advanced US training beyond residency.
AB - Introduction: Transthoracic echocardiography (TTE) is a standard procedure for emergency physicians (EPs). Transesophageal echocardiography (TEE) is known to have great utility in patients who are critically ill or in cardiac arrest and has been used by some EPs with specialized ultrasound (US) training, but it is generally considered outside the reach of the majority of EPs. We surmised that all of our EPs could learn to perform focused TEE (F-TEE), so we trained and credentialed all of the physicians in our group. Methods: We trained 52 EPs to perform and interpret F-TEEs using a 4-h simulator-based course. We kept a database of all F-TEE examinations for quality assurance and continuous quality feedback. Data are reported using descriptive statistics. Results: Emergency physicians attempted 557 total F-TEE examinations (median = 10, interquartile range = 5–15) during the 42-month period following training. Clinically relevant images were obtained in 99% of patients. EPs without fellowship or other advanced US training performed the majority of F-TEEs (417, 74.9%) and 94.3% (95% confidence interval [CI] = 91.4%–96.3%) had interpretable images recorded. When TTE and TEE were both performed (n = 410), image quality of TEE was superior in 378 (93.3%, 95% CI = 89.7%–95%). Indications for F-TEE included periarrest states (55.7%), cardiac arrest (32.1%), and shock (12.2%). There was one case of endotracheal tube dislodgement during TEE placement, but this was immediately identified and replaced without complication. Conclusion: After initiating a mandatory group F-TEE training and credentialing program, we report the largest series to date of EP-performed resuscitative F-TEE. The majority of F-TEE examinations (75%) were performed by EPs without advanced US training beyond residency.
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U2 - 10.1111/acem.14399
DO - 10.1111/acem.14399
M3 - Article
C2 - 34644420
AN - SCOPUS:85118478180
SN - 1069-6563
VL - 29
SP - 334
EP - 343
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 3
ER -