Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey

Authors

Felipe Teran, Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA. Electronic address: fet4003@med.cornell.edu.
Frances Mae West, Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Thomas Jefferson University, Pennsylvania, PA, USA.
Tom Jelic, Department of Emergency Medicine, University of Winnipeg, Manitoba, MB, Canada.
Lindsay Taylor, Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Zan M. Jafry, Department of Emergency Medicine, Loma Linda University, CA, USA.
Katharine M. Burns, Advocate Aurora HealthFollow
Clark G. Owyang, Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Joan and Stanford I. Weill Medical College of Cornell University, New York, NY, USA.
Claire Centeno Emt, Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Benjamin S. Abella, Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Phillip Andrus, Department of Emergency Medicine, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.

Recommended Citation

Teran F, West FM, Jelic T, et al. Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey. Am J Emerg Med. 2024;76:164-172. doi:10.1016/j.ajem.2023.11.041

Affiliations

Advocate Christ Medical Center

Abstract

Introduction:Over the past two decades, transesophageal echocardiography (TEE) has been used with increasing frequency to evaluate critically ill patients outside of traditional settings. The purpose of this study was to characterize the number of programs, users, practice characteristics, training and competency requirements and barriers for the current use of resuscitative transesophageal echocardiography (TEE) in Emergency Departments (EDs) in the United States and Canada.

Methods:A closed internet-based, cross-sectional, point-prevalence survey was administered via email to 120 program directors of emergency ultrasound fellowships (EUSF) and 43 physicians from EDs without EUSF from the United States and Canada.

Results:Ninety-eight percent of surveyed participants responded. Twenty percent of respondents reported having active resuscitative TEE programs. The majority of participating hospitals (70%) were academic centers with residency programs. A total of 33 programs reported using resuscitative TEE in their ED and of those, 82% were programs with EUSF. Most programs performing TEE (79%) had less than five attending physicians performing TEE. Evaluation of patients during resuscitation from cardiac arrest (100%) and post-arrest care (76%) are the two most frequent indications for TEE in the ED. The most common core elements of resuscitative TEE protocols used are: assessment of left ventricular (LV) systolic function (97%), assessment of right ventricular (RV) function (88%), evaluation of pericardial effusion / tamponade (52%). All programs reported using formal didactics in their training programs, 94% reported using high-fidelity simulation, and 79% live scanning of patients. Financial concerns were the most common barrier use of TEE in the ED (58%), followed by maintenance of equipment (30%), and credentialing/privileges (30%).

Conclusions:This study provides a snapshot of the practice of resuscitative TEE in EDs in the United States and Canada revealing the existence of 33 programs using this emerging modality in the care of critically ill patients.

Type

Article

PubMed ID

38086182