Simulation-Based Resuscitative Transesophageal Echocardiography Training for Emergency Medicine Residents

Document Type

Article

Publication Date

11-21-2024

Journal Title

The Journal of emergency medicine

Abstract

BACKGROUND: Transesophageal echocardiography (TEE) is an emerging resuscitation tool in emergency medicine. Simulation-based training is necessary for teaching this skill set. There has been no evaluation of how simulation prepares emergency medicine (EM) residents to perform this skill in live patients. OBJECTIVES: The objective of this study is to evaluate competency following simulation training and performance of resuscitative TEE on live patients in the operating room (OR). METHODS: A prospective study at a single academic site, enrolling volunteer postgraduate year (PGY)2 and PGY3 EM residents. Residents underwent the following: Pretest examination to assess general TEE knowledge; 30-minute lecture on a resuscitative protocol: mid-esophageal four-chamber (ME4C), mid-esophageal long axis (MELAX), trans-gastric short axis (TGSAX) and ascending aortic short axis (AscAoSAX); Two 1-hour sessions with a HeartWorks TEE simulator led by a physician trained in resuscitative TEE; post-test examination; TEE examination in the OR with a cardiac anesthesiologist. Data were summarized with descriptive statistics. Test scores were compared with paired t-test or Wilcoxon rank-sum tests. RESULTS: Fifteen residents participated. The pretest mean score was 11.07, 95% CI: 9.35 to 12.79. The post-test mean score was 19.40, 95% CI: 18.94 to 19.86. A significant difference in scores was noted, t = -11.996, p < 0.0001. The OR assessment findings included: number of placement attempts (mean: 1.27; 95% CI: 1.01-1.52); clinically acceptable views (ME4C 93.3%, MELAX 93.3%, AscAoSAX 60%, and TGSAX 60%). Of 60 total views, 76.7% were acceptable. CONCLUSION: Simulation training in resuscitative TEE is an effective method for preparing EM residents to obtain and interpret TEE imaging in a live patient.

ISSN

0736-4679

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