Development and Implementation of a Multicenter Registry for Resuscitation-Focused Transesophageal Echocardiography

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine Pub Date : 2025-02-01 DOI:10.1016/j.annemergmed.2024.08.004

Felipe Teran MD, MSCE , Clark G. Owyang MD , Trenton C. Wray MD , John E. Hipskind MD , Justine Lessard MD , William Bédard Michel MD , Chantal Lanthier , Peiman Nazerian MD , Eleonora de Villa MD , Jonathan Nogueira DO , Daniel Doynow DO, MPH , Michelle Clinton MD , Frank Myslik MD , Ross Prager MD , Robert Arntfield MD , Pedro D. Salinas MD , Vladyslav Dieiev MD , Michael Y. Woo MD , Rajiv Thavanathan MD , Graeme Puskas BSc , Benjamin S. Abella MD, MPhil

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引用次数: 0

Abstract

Study objective

To evaluate the clinical effect, safety, and clinical outcomes of focused transesophageal echocardiography (TEE) in the evaluation of critically ill patients in the emergency department (ED) and ICUs.

Methods

We established a prospective, multicenter, observational registry involving adult critically ill patients in whom focused TEE was performed for evaluation of out-of-hospital cardiac arrest (OHCA), inhospital cardiac arrest, evaluation of undifferentiated shock, hemodynamic monitoring, and/or procedural guidance in the ED, ICU, or operating room setting. The primary objective of the current investigation was to evaluate the clinical influence and safety of focused, point-of-care TEE in critically ill patients. Data elements included patient and procedure characteristics, laboratory values, timing of interventions, clinical outcomes, and TEE video images.

Results

A total of 1,045 focused TEE studies were collected among 916 patients from 28 hospitals, including 585 (64%) intraarrest and postarrest OHCA and inhospital cardiac arrest, 267 (29%) initial evaluation of undifferentiated shock, 101 (11%) procedural guidance, and 92 (10%) hemodynamic monitoring. TEE changed management in 85% of patients with undifferentiated shock, 71% of patients with inhospital cardiac arrest, and 62% of patients with OHCA. There were no reported esophageal perforations or oropharyngeal injuries, and other procedural complications were rare.

Conclusions

A prospective, multicenter, and multidisciplinary TEE registry was successfully implemented, and demonstrated that focused TEE is safe and clinically impactful across multiple critical care applications. Further studies from this research network will accelerate the development of outcome-oriented research and knowledge translation on the use of TEE in emergency and critical care settings.

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开发和实施以复苏为重点的经食道超声心动图多中心登记系统。

研究目的评估聚焦经食道超声心动图 (TEE) 在评估急诊科 (ED) 和重症监护室重症患者时的临床效果、安全性和临床结局。方法我们建立了一个前瞻性、多中心、观察性登记处，涉及在急诊科、重症监护室或手术室环境中进行聚焦经食道超声心动图检查以评估院外心脏骤停 (OHCA)、院内心脏骤停、未分化休克评估、血流动力学监测和/或程序指导的成年重症患者。本次调查的主要目的是评估重症患者集中式床旁 TEE 的临床影响和安全性。结果从 28 家医院的 916 名患者中共收集到 1045 次聚焦 TEE 研究，其中包括 585 例（64%）骤停中和骤停后 OHCA 以及院内心脏骤停患者、267 例（29%）未分化休克初步评估患者、101 例（11%）程序指导患者以及 92 例（10%）血液动力学监测患者。TEE 改变了 85% 未分化休克患者、71% 院内心脏骤停患者和 62% OHCA 患者的治疗方案。没有食管穿孔或口咽损伤的报告，其他程序并发症也很少发生。结论成功实施了前瞻性、多中心和多学科 TEE 注册，并证明了聚焦 TEE 在多种重症监护应用中是安全和具有临床影响力的。该研究网络的进一步研究将加速急诊和重症监护环境中使用 TEE 的成果导向型研究和知识转化的发展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of emergency medicine 医学-急救医学

CiteScore

8.30

自引率

4.80%

发文量

819

审稿时长

20 days

期刊介绍： Annals of Emergency Medicine, the official journal of the American College of Emergency Physicians, is an international, peer-reviewed journal dedicated to improving the quality of care by publishing the highest quality science for emergency medicine and related medical specialties. Annals publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine. In addition to general emergency medicine topics, Annals regularly publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics.