Development and implementation of a multicenter registry for resuscitation-focused transesophageal echocardiography

Authors

Felipe Teran, Department of Emergency Medicine, Weill Cornell Medicine, New York, NY. Electronic address: fet4003@med.cornell.edu.
Clark G. Owyang, Department of Emergency Medicine, Weill Cornell Medicine, New York, NY; Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY.
Trenton C. Wray, Division of Critical Care, Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM.
John E. Hipskind, Department of Emergency Medicine, Kaweah Health, Visalia, CA.
Justine Lessard, Department of Emergency Medicine Sacred Heart Hospital of Montréal, Montréal, QC, Canada.
William Bédard Michel, Department of Emergency Medicine Sacred Heart Hospital of Montréal, Montréal, QC, Canada.
Chantal Lanthier, Department of Emergency Medicine Sacred Heart Hospital of Montréal, Montréal, QC, Canada.
Peiman Nazerian, Department of Emergency Medicine University Hospital Careggi, Florence, FI, Italy.
Eleonora de Villa, Department of Emergency Medicine University Hospital Careggi, Florence, FI, Italy.
Jonathan Nogueira, Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA.
Daniel Doynow, Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA.
Michelle Clinton, Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA.
Frank Myslik, Department of Emergency Medicine, London Health Sciences Centre, London, ON, Canada.
Ross Prager, Division of Critical Care Medicine, Western University, London, ON, Canada.
Robert Arntfield, Medicine, London Health Sciences Centre, London, ON, Canada.
Pedro D. Salinas, Advocate Health - MidwestFollow
Vladyslav Dieiev, Advocate Health - MidwestFollow
Michael Y. Woo, Department of Emergency Medicine The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Rajiv Thavanathan, Department of Emergency Medicine The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Graeme Puskas, Department of Emergency Medicine The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Karan Singh, Department of Medicine, Medical Center of Bowling Green, Bowling Green, KY.
Priyanka Bhat, Department of Medicine, Medical Center of Bowling Green, Bowling Green, KY.
Jackson Horn, Western Kentucky Heart and Lung Research Foundation, Medical Center of Bowling Green, Bowling Green, KY.
Brian M. Buchanan, Department of Critical Care Medicine University of Alberta Hospital, Edmonton, AB, Canada.
Nadia Baig, Department of Critical Care Medicine University of Alberta Hospital, Edmonton, AB, Canada.
Katharine M. Burns, Advocate Health - MidwestFollow
Kelsey Kennedy, Advocate Health - MidwestFollow
et al

Recommended Citation

Teran F, Owyang CG, Wray TC, et al. Development and Implementation of a Multicenter Registry for Resuscitation-Focused Transesophageal Echocardiography. Ann Emerg Med. Published online October 15, 2024. doi:10.1016/j.annemergmed.2024.08.004

Affiliations

Aurora St. Luke's Medical Center, Advocate Christ Medical Center

Abstract

Study objective:To evaluate the clinical effect, safety, and clinical outcomes of focused transesophageal echocardiography (TEE) in the evaluation of critically ill patients in the emergency department (ED) and ICUs.

Methods:We established a prospective, multicenter, observational registry involving adult critically ill patients in whom focused TEE was performed for evaluation of out-of-hospital cardiac arrest (OHCA), inhospital cardiac arrest, evaluation of undifferentiated shock, hemodynamic monitoring, and/or procedural guidance in the ED, ICU, or operating room setting. The primary objective of the current investigation was to evaluate the clinical influence and safety of focused, point-of-care TEE in critically ill patients. Data elements included patient and procedure characteristics, laboratory values, timing of interventions, clinical outcomes, and TEE video images.

Results:A total of 1,045 focused TEE studies were collected among 916 patients from 28 hospitals, including 585 (64%) intraarrest and postarrest OHCA and inhospital cardiac arrest, 267 (29%) initial evaluation of undifferentiated shock, 101 (11%) procedural guidance, and 92 (10%) hemodynamic monitoring. TEE changed management in 85% of patients with undifferentiated shock, 71% of patients with inhospital cardiac arrest, and 62% of patients with OHCA. There were no reported esophageal perforations or oropharyngeal injuries, and other procedural complications were rare.

Conclusions:A prospective, multicenter, and multidisciplinary TEE registry was successfully implemented, and demonstrated that focused TEE is safe and clinically impactful across multiple critical care applications. Further studies from this research network will accelerate the development of outcome-oriented research and knowledge translation on the use of TEE in emergency and critical care settings.

Type

Article

PubMed ID

39412464