Focused Transesophageal Echocardiography by Emergency Physicians is Feasible and Clinically Influential: Observational Results from a Novel Ultrasound Program.
BACKGROUND
Emergency physicians frequently employ transthoracic echocardiography (TTE) to assist in diagnosis and therapy for patients with circulatory failure or arrest. In critically ill patients, transesophageal echocardiography (TEE) offers several advantages over TTE, including reliable, continuous image acquisition and superior image quality. Despite these advantages, TEE is not widely used by emergency physicians.


OBJECTIVE
Report the feasibility, findings, and clinical influence observed from the first described TEE program implemented in an emergency department (ED) point-of-care ultrasound program.


METHODS
This was a retrospective review of all ED TEE examinations carried out between February 1, 2013 and January 30, 2015. TEE images and report details (including operator, indication, findings, and clinical recommendation[s]) were exported from the institutional ultrasound archive and analyzed. The electronic chart of each patient was subsequently reviewed for the presence of any complications related to the examination and their clinical course in the hospital.


RESULTS
A total of 54 TEE examinations were performed by 12 different emergency physicians. All patients were intubated, and 98% of the examinations were determinate. The most common indications for TEE were intracardiac arrest care in 23 (43%), postarrest management in 14 (26%), and undifferentiated hypotension in 16 (40%). Probe insertion was successful in all cases. TEE imparted a diagnostic influence in 78% of cases and impacted therapeutic decisions in 67% of cases.


CONCLUSIONS
From our analysis of a single-center experience, ED-based TEE showed a high degree of feasibility and clinical utility, with a diagnostic and therapeutic influence seen in the majority of cases. Focused TEE demonstrated strongest uptake among intubated patients with either undifferentiated shock or cardiac arrest.
Division of Emergency Medicine, Western University, London, Ontario, Canada; Division of Critical Care Medicine, Western University, London, Ontario, Canada.
Robert
R
Arntfield
Division of Emergency Medicine, Western University, London, Ontario, Canada.
Jacob
J
Pace
Faculty of Medicine and Dentistry, Western University, London, Ontario, Canada.
Michael
M
Hewak
Division of Emergency Medicine, Western University, London, Ontario, Canada.
Drew
D
Thompson
D000066491:Clinical Decision-Making; D017548:Echocardiography, Transesophageal / Q000009:adverse effects; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012189:Retrospective Studies
cardiac arrest; critical care; echocardiography; imaging; new technology; point-of-care ultrasound; resuscitation; transesophageal echocardiography; ultrasound