Focused transesophageal echocardiography for emergency physicians—description and results from simulation training of a structured four-view examination

Abstract

BackgroundTransesophageal echocardiography (TEE) offers several advantages over transthoracic echocardiography (TTE). 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.ObjectiveThis 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.MethodsAcademic EPs were invited to participate in a 4-h didactic and simulation-based workshop. The seminar emphasized TEE principles and views obtained from four vantage points. Following the training, participants engaged in an assessment of their abilities to carry out a focused TEE on a high-fidelity simulator. A 6-week follow-up session assessed skill retention.ResultsFourteen EPs participated in this study. 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. 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. 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).ConclusionThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-015-0027-3) contains supplementary material, which is available to authorized users.

Intraoperative Transesophageal Echocardiography: Review and Evolution

“…These platforms are especially important to TEE-naïve since improves expertise, speed learning and comfort with TEE [65][66][67][68][69].…”

Transesophageal echocardiography: A new era for the critical care physician

“…Fifty-three of the 54 studies were determinate making it a reliable tool. Furthermore, 78% of the studies had diagnostic influence and impacted therapeutic decisions in 67% of TEEs.These studies demonstrate a much faster training curve [5,6] and greater clinical utility [4] than expected. Commonly, incorporation of TEE meets a great deal of resistance due to the cost of the TEE probe (estimated at $40,000 USD [4]), interdepartmental politics and lack of established training models [4].…”

“…These trainees were then trained in advanced TEE and assessed at one, three and six months. This study found that the performance of at least 31 examinations over six months were required to reach competence in advanced TEE.In 2015, Arntfield, et al, expanded on the use of TEE as an additional form of basic point of care ultrasound in the emergency department [6]. This study trained a small group of emergency physicians experienced in TTE to perform a basic four view TEE [6].…”

“…Transthoracic echocardiography (TTE) is currently the preferred method in assessing cardiac function and haemodynamic status despite its well-known limitations [4]. For this reason a number of studies have investigated the feasibility and applications of transesophageal echocardiography (TEE) in the critical care setting [4][5][6].…”

“…Transthoracic echocardiography (TTE) is currently the preferred method in assessing cardiac function and haemodynamic status despite its well-known limitations [4]. For this reason a number of studies have investigated the feasibility and applications of transesophageal echocardiography (TEE) in the critical care setting [4][5][6].In 2013, Charron et al, performed a study investigating the minimum training requirements of non-cardiologists to perform an advanced point of care TEE [5]. In this study, each participant was an intensive care trainee with little or no experience with echocardiography.…”