Simulation-Based Resuscitative Transesophageal Echocardiography Training for Emergency Medicine Residents.
Background: Transesophageal echocardiography (TEE) is an emerging resuscitation tool in emergency medicine. Simulation-based training is necessary for teaching this skill set. There has been no evaluation of how simulation prepares emergency medicine (EM) residents to perform this skill in live patients.
Objective: The objective of this study is to evaluate competency following simulation training and performance of resuscitative TEE on live patients in the operating room (OR).
Methods: A prospective study at a single academic site, enrolling volunteer postgraduate year (PGY)2 and PGY3 EM residents. Residents underwent the following: Pretest examination to assess general TEE knowledge; 30-minute lecture on a resuscitative protocol: mid-esophageal four-chamber (ME4C), mid-esophageal long axis (MELAX), trans-gastric short axis (TGSAX) and ascending aortic short axis (AscAoSAX); Two 1-hour sessions with a HeartWorks TEE simulator led by a physician trained in resuscitative TEE; post-test examination; TEE examination in the OR with a cardiac anesthesiologist. Data were summarized with descriptive statistics. Test scores were compared with paired t-test or Wilcoxon rank-sum tests.
Results: Fifteen residents participated. The pretest mean score was 11.07, 95% CI: 9.35 to 12.79. The post-test mean score was 19.40, 95% CI: 18.94 to 19.86. A significant difference in scores was noted, t = -11.996, p < 0.0001. The OR assessment findings included: number of placement attempts (mean: 1.27; 95% CI: 1.01-1.52); clinically acceptable views (ME4C 93.3%, MELAX 93.3%, AscAoSAX 60%, and TGSAX 60%). Of 60 total views, 76.7% were acceptable.
Conclusions: Simulation training in resuscitative TEE is an effective method for preparing EM residents to obtain and interpret TEE imaging in a live patient.