Advantages, Implementation Methods, and Barriers to Successful use of Focused Transesophageal Echocardiography in Emergency Departments.

BACKGROUND

The use of point-of-care ultrasound in the emergency department (ED) has undergone major transformation in the past decade, with improvement in technology and implementation of curriculum changes in residency and fellowship programs. While transthoracic echocardiography has been utilized to evaluate cardiac structure and function, significant limitations exist during cardiopulmonary resuscitation (CPR). Transesophageal echocardiography (TEE) has thus emerged as a preferred tool during resuscitation.

OBJECTIVES

This literature review article aims to discuss the advantages and disadvantages of TEE use in CPR, methods of ED implementation, and the barriers to successful system-wide ED implementation. A literature review was performed utilizing various databases, including MEDLINE/PubMed and the Cochrane Library.

DISCUSSION: TEE confers a number of advantages in cardiac arrest, including optimization of chest compressions, minimization of pulse checks, identification of thoracic injuries, and rapid recognition of underlying cardiovascular pathology. Despite these potential advantages, TEE has not been broadly adopted. There has been extensive research on the barriers to implementation and multiple perspectives on physician training. Previous publications have considered the various factors and guidelines for implementing and integrating TEE in the ED. There is widespread acceptance that combining didactic and hands-on training is the most appropriate training method. However, the time commitment, quality, and quantity of supervised examinations on either live or simulation models is debated.

CONCLUSION

TEE demonstrates significant advantages during CPR; however, implementation in the ED is limited due to issues with costs, interdepartmental coordination, quality assurance, and credentialing. Further studies are needed to assess the feasibility of implementing TEE in cardiac arrest patients and outline the logistics of how to introduce system-wide use of TEE in an ED.