Emergency Physician-performed Transesophageal Echocardiography in Simulated Cardiac Arrest

Autor: Michael J. Vitto, Turan Kayagil, Matt Jones, Jordan Tozer, Don Byars, David Evans, Matthew C. Bishop, John Michael Joyce, Barry J. Knapp, Lindsay Taylor
Rok vydání: 2017
Předmět:
Models
Educational
medicine.medical_specialty
medicine.medical_treatment
lcsh:Medicine
030204 cardiovascular system & hematology
Likelihood ratios in diagnostic testing
Education
03 medical and health sciences
0302 clinical medicine
Cohen's kappa
Internal medicine
Positive predicative value
medicine
Humans
Myocardial infarction
Cardiopulmonary resuscitation
Asystole
Original Research
transesophageal echocardiography
cardiac arrest
educational protocol
business.industry
lcsh:R
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Internship and Residency
030208 emergency & critical care medicine
lcsh:RC86-88.9
General Medicine
medicine.disease
Cardiopulmonary Resuscitation
Heart Arrest
Education
Medical
Graduate
Ventricular fibrillation
Emergency Medicine
Cardiology
Clinical Competence
Educational Measurement
Tamponade
business
Echocardiography
Transesophageal
Zdroj: Western Journal of Emergency Medicine
Byars, Don V.; Tozer, Jordan; Joyce, John M.; Vitto, Michael J.; Taylor, Lindsay; Kayagil, Turan; et al.(2017). Emergency Physician-performed Transesophageal Echocardiography in Simulated Cardiac Arrest. Western Journal of Emergency Medicine, 18(5). doi: 10.5811/westjem.2017.5.33543. Retrieved from: http://www.escholarship.org/uc/item/69n342mp
Western Journal of Emergency Medicine, Vol 18, Iss 5 (2017)
ISSN: 1936-900X
DOI: 10.5811/westjem.2017.5.33543
Popis: Introduction: Transesophageal echocardiography (TEE) is a well-established method of evaluatingcardiac pathology. It has many advantages over transthoracic echocardiography (TTE), including theability to image the heart during active cardiopulmonary resuscitation. This prospective simulation studyaims to evaluate the ability of emergency medicine (EM) residents to learn TEE image acquisitiontechniques and demonstrate those techniques to identify common pathologic causes of cardiac arrest. Methods: This was a prospective educational cohort study with 40 EM residents from two participatingacademic medical centers who underwent an educational model and testing protocol. All participantswere tested across six cases, including two normals, pericardial tamponade, acute myocardial infarction(MI), ventricular fibrillation (VF), and asystole presented in random order. Primary endpoints were correctidentification of the cardiac pathology, if any, and time to sonographic diagnosis. Calculated endpointsincluded sensitivity, specificity, and positive and negative predictive values for emergency physician (EP)-performed TEE. We calculated a kappa statistic to determine the degree of inter-rater reliability. Results: Forty EM residents completed both the educational module and testing protocol. This resultedin a total of 80 normal TEE studies and 160 pathologic TEE studies. Our calculations for the abilityto diagnose life-threatening cardiac pathology by EPs in a high-fidelity TEE simulation resulted in asensitivity of 98%, specificity of 99%, positive likelihood ratio of 78.0, and negative likelihood ratio of0.025. The average time to diagnose each objective structured clinical examination case was as follows:normal A in 35 seconds, normal B in 31 seconds, asystole in 13 seconds, tamponade in 14 seconds,acute MI in 22 seconds, and VF in 12 seconds. Inter-rater reliability between participants was extremelyhigh, resulting in a kappa coefficient across all cases of 0.95. Conclusion: EM residents can rapidly perform TEE studies in a simulated cardiac arrest environmentwith a high degree of precision and accuracy. Performance of TEE studies on human patients in cardiacarrest is the next logical step to determine if our simulation data hold true in clinical practice. [West JEmerg Med. 2017;18(5)830-834.]
Databáze: OpenAIRE
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