The following is a summary of “Resuscitative transesophageal echocardiography in emergency departments in the United States and Canada: A cross-sectional survey,” published in the February 2024 issue of Emergency Medicine by Teran, et al.

In recent years, the utilization of transesophageal echocardiography (TEE) in evaluating patients who are critically ill outside of traditional settings has seen a notable increase. For a study, researchers sought to characterize the current landscape of resuscitative TEE use in Emergency Departments (EDs) across the United States and Canada, focusing on the number of programs, users, practice characteristics, training requirements, and barriers.

A closed internet-based, cross-sectional, point-prevalence survey was conducted, targeting 120 program directors of emergency ultrasound fellowships (EUSF) and 43 physicians from EDs without EUSF in the United States and Canada. The survey encompassed inquiries regarding active resuscitative TEE programs, hospital demographics, indications for TEE use, core elements of TEE protocols, training methods, and perceived barriers to implementation.

A robust response rate of 98% was achieved, with 20% of participants reporting active resuscitative TEE programs in their respective EDs. Most surveyed hospitals (70%) were academic centers with residency programs, and 82% of programs utilizing TEE were affiliated with EUSF. Notably, 79% of programs had fewer than five attending physicians proficient in TEE. The primary indications for TEE use included evaluation during resuscitation from cardiac arrest (100%) and post-arrest care (76%). Core elements of resuscitative TEE protocols predominantly encompassed assessing left ventricular (LV) systolic function (97%), right ventricular (RV) function (88%), and pericardial effusion/tamponade (52%). Training methods commonly included formal didactics (100%), high-fidelity simulation (94%), and live patient scanning (79%). Financial concerns emerged as the most prevalent barrier to TEE implementation (58%), followed by equipment maintenance (30%) and credentialing/privileges (30%).

The study shed light on the utilization of resuscitative TEE in EDs across the United States and Canada, revealing the presence of 33 programs employing this emerging modality in the care of patients who are critically ill. The findings underscored the growing importance of TEE in ED settings and highlight areas for further exploration and improvement in training and implementation practices.

Reference: sciencedirect.com/science/article/abs/pii/S073567572300654X