Goal-Directed Transthoracic Echocardiography During Advanced Cardiac Life Support: A Pilot Study Using Simulation to Assess Ability.
BACKGROUND
Goal-directed echocardiography (GDE) is used to answer specific clinical questions that provide invaluable information to physicians managing a hemodynamically unstable patient. We studied perception and ability of house staff previously trained in GDE to accurately diagnose common causes of cardiac arrest during simulated advanced cardiac life support (ACLS); we compared their results with those of expert echocardiographers.


METHODS
Eleven pulmonary and critical care medicine fellows, 7 emergency medicine residents, and 5 cardiologists board certified in echocardiography were enrolled. Baseline ability to acquire 4 transthoracic echocardiography views was assessed, and participants were exposed to 6 simulated cardiac arrests and were asked to perform a GDE during ACLS. House staff performance was compared with the performance of 5 expert echocardiographers.


RESULTS
Average baseline and scenario views by house staff were of good or excellent quality 89% and 83% of the time, respectively. Expert average baseline and scenario views were always of good or excellent quality. House staff and experts made the correct diagnosis in 68% and 77% of cases, respectively. On average, participants required 1.5 pulse checks to make the correct diagnosis. Of house staff, 94% perceived this study as an accurate assessment of ability.


CONCLUSIONS
In an ACLS-compliant manner, house staff are capable of diagnosing management-altering pathologies the majority of the time, and they reach similar diagnostic conclusions in the same amount of time as expert echocardiographers in a simulated cardiac arrest scenario.
From the Division of Pulmonary and Critical Care Medicine (Y.Y.G., T.J.M., K.F., B.K.), Department of Medicine, New York University Medical Center; New York Harbor VA Hospital (KF, BK, TJM); and Division of Biostatistics (L.R.), New York University School of Medicine, New York, NY.
Yonatan Y
YY
Greenstein
Thomas J
TJ
Martin
Linda
L
Rolnitzky
Kevin
K
Felner
Brian
B
Kaufman
D022561:Advanced Cardiac Life Support / Q000193:education*; D002309:Cardiology / Q000193:education; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D004635:Emergency Medicine / Q000193:education; D006323:Heart Arrest / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D010865:Pilot Projects; D000066908:Simulation Training / Q000379:methods* / Q000592:standards