Focused transoesophageal TOE (fTOE): A new accreditation pathway

Area of Science:

• Critical Care Medicine
• Cardiovascular Imaging
• Medical Education

Background:

• Point-of-care ultrasound (POCUS) with transthoracic protocols aids haemodynamic instability management.
• Transoesophageal echocardiography (TOE) offers advantages over transthoracic scans in specific patient populations.
• Limitations of transthoracic ultrasound include obesity, chest trauma, and positive airway pressure.

Purpose of the Study:

• To introduce the Focused Transoesophageal Echo (fTOE) accreditation pathway for acute care practitioners.
• To enable non-cardiologists to identify causes of haemodynamic instability using focused TOE.
• To expand the diagnostic capabilities for managing haemodynamically unstable patients.

Main Methods:

• The Intensive Care Society (ICS) and Association of Anaesthetists (AA) launched the fTOE accreditation in 2022.
• Training involves theoretical modules, clinical cases, and multiple-choice questions.
• Accreditation requires a logbook of 50 fTOE examinations covering diverse pathologies and a final practical assessment.

Main Results:

• The fTOE pathway provides essential information for diagnosing haemodynamic instability.
• Focused TOE training is achievable in a shorter timeframe compared to comprehensive programs.
• Accreditation requires ongoing medical education to maintain competence.

Conclusions:

• fTOE accreditation is a joint initiative by ICS and AA, endorsed by ACTACC.
• This pathway equips acute care practitioners with advanced skills for haemodynamic assessment.
• fTOE represents a significant advancement in the management of critically ill patients.