Critical Care |

Goal-Directed Transthoracic Echocardiography: Using Simulation to Assess Ability FREE TO VIEW

Yonatan Greenstein, MD; Thomas Martin, MD; Kevin Felner, MD; Brian Kaufman, MD
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New York University School of Medicine, New York City, NY

Chest. 2013;144(4_MeetingAbstracts):373A. doi:10.1378/chest.1702643
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SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Goal-directed echocardiography (GDE) is used to answer specific clinical questions which can provide invaluable and timely information to the critical care physician. Studies that assess competency are lacking. We studied perception and ability of housestaff previously trained in GDE to accurately diagnose common causes of cardiac arrest during simulated cardiac arrest scenarios, and we compared them to expert echocardiographers.

METHODS: 14 housestaff subjects with prior GDE training were enrolled. Subjects answered a pre-study questionnaire and had time to familiarize themselves with the transthoracic echocardiography simulator. A baseline assessment was conducted whereby subjects obtained four standard cardiac windows (parasternal long, parasternal short, subcostal, and apical four chamber). Subjects were exposed to six simulated cardiac arrest scenarios. They were given relevant clinical information and were asked to perform a GDE during pulse checks which lasted ten seconds. Three GDE attempts were allowed and if no diagnosis was offered, a final twenty second interval was allowed. Subjects were debriefed and filled out a post-study questionnaire. All echocardiography views were graded on a scale of zero to three. Subject performance was compared to the performance of three expert echocardiographers.

RESULTS: 21% of subjects reported comfort using GDE independently, while 71% preferred attending oversight. Baseline and scenario views by subjects were of good quality 93% and 79% of the time, respectively. Expert baseline and scenario views were of good quality 100% of the time. Subjects and experts made the correct diagnosis in 68% and 72% of cases, respectively. On average, subjects and experts required 1.5 pulse checks for the correct diagnosis. 93% of subjects perceived this study as an accurate assessment of ability and felt more comfortable with GDE at its conclusion.

CONCLUSIONS: Housestaff with prior GDE training reach similar diagnostic conclusions in the same amount of time as expert echocardiographers in a simulated code scenario.

CLINICAL IMPLICATIONS: Use of a transthoracic echocardiography simulator is a novel and practical method of assessing skill and training housestaff in GDE.

DISCLOSURE: The following authors have nothing to disclose: Yonatan Greenstein, Thomas Martin, Kevin Felner, Brian Kaufman

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