Adopting Transesophageal Echocardiography by CRNAs in Noncardiac Surgery: A Prospective Cohort Observational Study.

Abstract

This study considered a cohort of 15 practicing certified registered nurse anesthetists (CRNAs) who completed a 1-day didactic and simulation-based workshop on focused transesophageal echocardiography (TEE) for noncardiac surgery. Data were acquired by survey and knowledge-based testing immediately pre- and postworkshop, and after 3 months. The primary aims of the study were to determine the extent that workshop-trained CRNAs incorporated TEE into their noncardiac surgery practice soon after program completion and to identify perceived barriers to this process. The study also evaluated both initial acquisition and short-term retention of TEE knowledge. CRNA education in focused TEE to provide entry-level skills into practice via a 1-day workshop is feasible, acceptable, and has perceived utility. Preworkshop, 33% of the cohort utilized TEE during noncardiac surgery; 13% who had not previously utilized TEE incorporated it de novo into their practices within 3 months. The most common reason for failure to use TEE during noncardiac surgery postworkshop was lack of a TEE machine or an appropriate surgical patient. Other reasons included lack of a supervising anesthesiologist agreeable to doing so or lack of TEE privileges. As assessed by written evaluation, there was both significant knowledge acquisition and short-term retention associated with this workshop.