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Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice
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) trai...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9298053/ https://www.ncbi.nlm.nih.gov/pubmed/34644420 http://dx.doi.org/10.1111/acem.14399 |
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author | Reardon, Robert F. Chinn, Elliott Plummer, Dave Laudenbach, Andrew Rowland Fisher, Andie Smoot, Will Lee, Daniel Novik, Joseph Wagner, Barrett Kaczmarczyk, Chris Moore, Johanna Thompson, Emily Tschautscher, Craig Dunphy, Teresa Pahl, Thomas Puskarich, Michael A. Miner, James R. |
author_facet | Reardon, Robert F. Chinn, Elliott Plummer, Dave Laudenbach, Andrew Rowland Fisher, Andie Smoot, Will Lee, Daniel Novik, Joseph Wagner, Barrett Kaczmarczyk, Chris Moore, Johanna Thompson, Emily Tschautscher, Craig Dunphy, Teresa Pahl, Thomas Puskarich, Michael A. Miner, James R. |
author_sort | Reardon, Robert F. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9298053 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92980532022-07-21 Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice Reardon, Robert F. Chinn, Elliott Plummer, Dave Laudenbach, Andrew Rowland Fisher, Andie Smoot, Will Lee, Daniel Novik, Joseph Wagner, Barrett Kaczmarczyk, Chris Moore, Johanna Thompson, Emily Tschautscher, Craig Dunphy, Teresa Pahl, Thomas Puskarich, Michael A. Miner, James R. Acad Emerg Med Original Contributions 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. John Wiley and Sons Inc. 2021-11-06 2022-03 /pmc/articles/PMC9298053/ /pubmed/34644420 http://dx.doi.org/10.1111/acem.14399 Text en © 2021 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Contributions Reardon, Robert F. Chinn, Elliott Plummer, Dave Laudenbach, Andrew Rowland Fisher, Andie Smoot, Will Lee, Daniel Novik, Joseph Wagner, Barrett Kaczmarczyk, Chris Moore, Johanna Thompson, Emily Tschautscher, Craig Dunphy, Teresa Pahl, Thomas Puskarich, Michael A. Miner, James R. Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice |
title | Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice |
title_full | Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice |
title_fullStr | Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice |
title_full_unstemmed | Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice |
title_short | Feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice |
title_sort | feasibility, utility, and safety of fully incorporating transesophageal echocardiography into emergency medicine practice |
topic | Original Contributions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9298053/ https://www.ncbi.nlm.nih.gov/pubmed/34644420 http://dx.doi.org/10.1111/acem.14399 |
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