Simulation-Based Resuscitative Transesophageal Echocardiography Training for Emergency Medicine Residents

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.

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).

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.

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.

Simulation training in resuscitative TEE is an effective method for preparing EM residents to obtain and interpret TEE imaging in a live patient.