Bianconi Kristopher, Hanna Mark, Visveswaran Gautam, Patel Reenal, Pompa Joseph, Glucksman Alec, Cavaliere Garrett, Steenberg Matthew, Tagore Ammundeep, Ariyaprakai Navin
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey.
Department of Cardiology, Newark Beth Israel Medical Center, Jersey, Newark, New Jersey.
Prehosp Emerg Care. 2025;29(6):820-825. doi: 10.1080/10903127.2024.2411720. Epub 2024 Nov 1.
Out of Hospital Cardiac Arrest (OHCA) is a frequently encountered pathology with resultant poor outcomes in the majority of patients. Echocardiography has been utilized to help guide clinical decision making and monitor effectiveness of resuscitative efforts. Transthoracic echocardiography (TTE) the mainstay of point-of-care ultrasound (POCUS) real time resuscitative imaging has limitations, most notably is the disruption of closed chest compressions. Trans-esophageal echocardiography (TEE) is an emerging technology in emergency care and can potentially overcome these limitations but image quality and accuracy of use in the prehospital environment remains unknown. Our primary objective is to identify the accuracy of Emergency Medical Services (EMS) fellow physicians in performing TEE via the identification of key cardiac structures. Secondarily we assess image quality as well as accuracy on cardiac activity interpretation as compared to TEE-experienced cardiologists.
A pilot study using descriptive analysis of a retrospective case-series with specific focus on inter-rater reliability as well as pragmatic management alterations based on real-time image interpretation by EMS physicians. After focused education, 13 patients were eligible for prehospital TEE who suffering OHCA from July 2022 to June 2023. Ultrasound (US) images were interpreted by EMS fellow physicians and over-read by cardiologists with specific focus on inter-rater reliability. After collection of patients presenting data and US images, analysis was performed.
Of 13 patients initially screened, 10 patients were included in a study with a median age of 50 years old (41-70). Three patients were excluded due to equipment malfunction or insufficient image capture. An interrater reliability identified a kappa of 0.96 with respect to identification of cardiac structures and a kappa of 0.65 for identification of cardiac activity.
In this small study of prehospital TEE, EMS fellow physicians had high inter-rater reliability in image interpretation pertaining to anatomy and cardiac activity when compared with cardiologists. Further research is needed to determine its efficacy, safety, and widespread application in the prehospital setting.
院外心脏骤停（OHCA）是一种常见病症，大多数患者预后不佳。超声心动图已被用于辅助临床决策并监测复苏效果。经胸超声心动图（TTE）作为床旁超声（POCUS）实时复苏成像的主要手段存在局限性，最显著的是会干扰胸外按压。经食管超声心动图（TEE）是急救领域的一项新兴技术，有可能克服这些局限性，但在院前环境中的图像质量和使用准确性仍不明确。我们的主要目标是通过识别关键心脏结构来确定急诊医疗服务（EMS）医师进行TEE操作的准确性。其次，我们将与有TEE经验的心脏病专家相比，评估图像质量以及对心脏活动解读的准确性。
一项试点研究，采用回顾性病例系列的描述性分析，特别关注评分者间的可靠性以及基于EMS医师实时图像解读的实际管理变更。经过集中培训后，2022年7月至2023年6月期间，13例因OHCA接受院前TEE检查的患者符合纳入标准。超声（US）图像由EMS医师解读，并由心脏病专家进行复核，特别关注评分者间的可靠性。收集患者的呈现数据和US图像后进行分析。
在最初筛查的13例患者中，10例纳入研究，中位年龄为50岁（41 - 70岁）。3例患者因设备故障或图像采集不足被排除。评分者间可靠性分析显示，心脏结构识别的kappa值为0.96，心脏活动识别的kappa值为0.65。
在这项关于院前TEE的小型研究中，与心脏病专家相比，EMS医师在图像解剖和心脏活动解读方面具有较高的评分者间可靠性。需要进一步研究以确定其在院前环境中的有效性、安全性和广泛应用。
