Nazerian Peiman, De Stefano Giuliano, Albano Giovanni, Gaspari Vera, Bevilacqua Sergio, Campagnolo Valter, Stefàno Pierluigi, Grifoni Stefano
Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Firenze, Italy.
Department of Anaesthesiology, Careggi University Hospital, Florence, Italy.
Ultrasound J. 2020 Aug 18;12(1):41. doi: 10.1186/s13089-020-00189-0.
Integration of transesophageal echocardiography (TEE) with Focused Cardiac Ultrasound (FoCUS) can impact decision-making, assist in the diagnosis of reversible etiologies and help guiding resuscitation of patients with cardiac arrest.
To evaluate the ability of emergency physicians (EPs) to obtain and maintain skills in performing resusTEE after a course with clinical training in the cardiac surgery theatre.
Ten EPs without previous TEE experience underwent a resusTEE course, based on a 2-h workshop and an 8-h hands-on training. The training was performed in a cardiac surgery theatre tutored by cardiovascular anesthesiologists. The six taught views were mid-esophageal four-chamber (ME4CH), mid-esophageal long axis (MELAX), mid-esophageal two-chamber (ME2CH), mid-esophageal bicaval view (MEbicaval), transgastric short axis (TGSAX) and aorta view (AOview). The EPs were evaluated by a cardiovascular anesthesiologist at the end of the course as well as after 12 weeks according to a standardized evaluation method. Once the course was completed, resusTEE exams, performed by EPs in Emergency Department (ED), were monitored for a 12-week period.
The average assessment of the ten EPs by the tutors was higher than 4 points out of 5, both at the end of the course and after 12 weeks. Probe insertion, acquisition and interpretation of the different views scored on average more than 4 points out of 5 except for TGSAX that showed worsening after 12 weeks. Trainees performed twelve resusTEE exams in ED in patients with out-of-hospital cardiac arrest (OHCA) over 12 weeks after the course. EPs used only four out of six taught views in clinical practice, in the following order of frequency: ME4CH, AOview, MEbicaval and MELAX.
EPs, after a course with clinical training in the cardiac surgery theatre, can successfully acquire and maintain the skills needed to perform resusTEE. However, among the six views learned in the course, EPs used only four of them (ME4CH, MEbicaval, MELAX and AOview).
经食管超声心动图（TEE）与心脏聚焦超声（FoCUS）的整合可影响决策，有助于诊断可逆病因，并有助于指导心脏骤停患者的复苏。
评估急诊医生（EPs）在心脏外科手术室接受临床培训课程后获得并维持进行复苏TEE技能的能力。
10名以前没有TEE经验的急诊医生参加了复苏TEE课程，该课程包括一个2小时的研讨会和8小时的实践培训。培训在心血管麻醉医生指导的心脏外科手术室进行。讲授的六个视图为食管中段四腔心（ME4CH）、食管中段长轴（MELAX）、食管中段两腔心（ME2CH）、食管中段双腔静脉视图（MEbicaval）、经胃短轴（TGSAX）和主动脉视图（AOview）。课程结束时以及12周后，由心血管麻醉医生根据标准化评估方法对急诊医生进行评估。课程完成后，对急诊医生在急诊科（ED）进行的复苏TEE检查进行了为期12周的监测。
导师对这10名急诊医生的平均评估在课程结束时和12周后均高于5分中的4分。除TGSAX在12周后显示恶化外，探头插入、不同视图的采集和解读平均得分超过5分中的4分。课程结束后12周内，学员们在急诊科对院外心脏骤停（OHCA）患者进行了12次复苏TEE检查。急诊医生在临床实践中仅使用了讲授的六个视图中的四个，按频率顺序如下：ME4CH、AOview、MEbicaval和MELAX。
急诊医生在心脏外科手术室接受临床培训课程后，可以成功获得并维持进行复苏TEE所需的技能。然而，在课程中学到的六个视图中，急诊医生仅使用了其中四个（ME4CH、MEbicaval、MELAX和AOview）。
