Danta Michael, Nguyen-Phuoc Alyssa Y, Gupta Suman, Sakhpara Aneri, Kurbedin Jeanette, Khordipour Errel, Likourezos Antonios, Haines Lawrence, Aghera Amish, Drapkin Jefferson, Lin Judy
Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.
University of California San Francisco-Fresno, Department of Emergency Medicine, Fresno, California.
West J Emerg Med. 2025 Mar 15;26(3):465-468. doi: 10.5811/westjem.20788.
The American College of Emergency Physicians recommends that transesophageal echocardiography (TEE) be used to "maintain the standard of ultrasound-informed resuscitation" in cardiac arrest. To date, no standards exist on how to train emergency physicians (EP) on TEE use in the emergency department (ED). We propose a novel educational paradigm using simulation to train EPs on the use of TEE in cardiac arrest.
A total of 63 EPs at a single-center academic teaching hospital participated in a 90-minute simulation-based education session to summarize the use of TEE in cardiac resuscitation and practice related procedural skills. The session consisted of a simulated cardiac arrest scenario using both transthoracic echocardiography (TTE) and TEE and hands-on practice on a high-fidelity TEE task trainer. Participants filled out anonymous surveys before and after the training session, which evaluated their subjective attitudes toward TEE, knowledge of its role in cardiac arrest, and perceived efficacy of the curriculum in introducing the modality.
Survey results indicated fewer perceived barriers to performing TEE in resuscitation after completion of the course, with statistically significant decreases in the following: not understanding image acquisition (85.5% pre vs 27.4% post; P<0.001), interpretation (66.1% pre vs 25.8% post; P<0.001), indications (29.0% pre vs 0.0% post; P<0.001), contraindications (35.5% pre vs. 3.2% post; P<0.001), and the potential benefit for the patient (24.2% pre vs 3.2% post; P <0.001). Finally, 68% of EPs stated they were "extremely likely" to use TEE in cardiac arrest with the availability of assistance from a credentialed attending.
The survey responses suggest that a short, simulation-based course can generate interest in the incorporation of TEE in cardiac resuscitation as well as overcome many of the perceived barriers regarding TEE. Moreover, they suggest that the participating academic EPs would be interested in using TEE in critical patients in the future when available.
美国急诊医师学会建议在心脏骤停时使用经食管超声心动图（TEE）来“维持超声指导下复苏的标准”。迄今为止，尚无关于如何在急诊科（ED）培训急诊医师（EP）使用TEE的标准。我们提出一种新颖的教育模式，利用模拟培训急诊医师在心脏骤停时使用TEE。
一家单中心学术教学医院的63名急诊医师参加了一场为时90分钟的基于模拟的教育课程，以总结TEE在心脏复苏中的应用并练习相关操作技能。该课程包括一个使用经胸超声心动图（TTE）和TEE的模拟心脏骤停场景，以及在高保真TEE任务训练器上的实践操作。参与者在培训课程前后填写了匿名调查问卷，评估他们对TEE的主观态度、对其在心脏骤停中作用的了解，以及对该课程介绍该技术的感知效果。
调查结果表明，课程结束后，在复苏中进行TEE操作时感知到的障碍减少，以下方面有统计学意义的下降：不理解图像采集（培训前85.5%，培训后27.4%；P<0.001）、解读（培训前66.1%，培训后25.8%；P<0.001）、适应症（培训前29.0%，培训后0.0%；P<0.001）、禁忌症（培训前35.5%，培训后3.2%；P<0.001）以及对患者的潜在益处（培训前24.2%，培训后3.2%；P<0.001）。最后，68%的急诊医师表示，在有资质的主治医生协助的情况下，他们“极有可能”在心脏骤停时使用TEE。
调查反馈表明，一个简短的基于模拟的课程能够激发将TEE纳入心脏复苏的兴趣，并克服许多关于TEE的感知障碍。此外，这表明参与的学术急诊医师未来在有条件时会有兴趣在危重症患者中使用TEE。
