Development and Implementation of a Multicenter Registry for Resuscitation-Focused Transesophageal Echocardiography - 20/01/25
Doi : 10.1016/j.annemergmed.2024.08.004
Felipe Teran, MD, MSCE a, ⁎ 
, Clark G. Owyang, MD a, c, Trenton C. Wray, MD d, John E. Hipskind, MD e, Justine Lessard, MD f, William Bédard Michel, MD f, Chantal Lanthier f, Peiman Nazerian, MD g, Eleonora de Villa, MD g, Jonathan Nogueira, DO h, Daniel Doynow, DO, MPH h, Michelle Clinton, MD h, Frank Myslik, MD i, Ross Prager, MD k, Robert Arntfield, MD j, Pedro D. Salinas, MD l, Vladyslav Dieiev, MD l, Michael Y. Woo, MD m, Rajiv Thavanathan, MD m, Graeme Puskas, BSc m, Karan Singh, MBBS n, Priyanka Bhat, MBBS n, Jackson Horn, BS o, Brian M. Buchanan, MD, MMEd p, Nadia Baig, BSc p, Katharine M. Burns, MD q, r, Kelsey Kennedy, MD q, Lawrence Haines, MD, MPH s, Leily Naraghi, MD s, Harpriya Singh, MD s, Michael Secko, MD t, Daniel Singer, MD t, Maria Taylor, RN, BSN t, John M. Joyce, MD u, Stephanie DeMasi, MD u, Zan M. Jafry, MD v, Tammy Phan, MD v, Natalie Truong, MD v, Evan Robinson, DO w, Korbin H. Haycock, MD x, Allyson Hansen, DO y, Charlotte Derr, MD y, Frances M. West, MD z, Mangala Narasimhan, DO aa, James Horowitz, MD cc, Asad Usman, MD, MPH dd, Kenton L. Anderson, MD ee, Yifan Peng, PhD ff, Philippe Rola, MD gg, Phillip Andrus, MD bb, Junaid Razzak, MD, PhD a, Hugh C. Hemmings, MD, PhD b, Rohan Panchamia, MD b, Joanna Palasz, MD a, Aarthi Kaviyarasu, BS hh, Nathaniel A. Sands, MPH hh, Robert M. Sutton, MD, MSCE ii, Benjamin S. Abella, MD, MPhil hh
On behalf of the
, Clark G. Owyang, MD a, c, Trenton C. Wray, MD d, John E. Hipskind, MD e, Justine Lessard, MD f, William Bédard Michel, MD f, Chantal Lanthier f, Peiman Nazerian, MD g, Eleonora de Villa, MD g, Jonathan Nogueira, DO h, Daniel Doynow, DO, MPH h, Michelle Clinton, MD h, Frank Myslik, MD i, Ross Prager, MD k, Robert Arntfield, MD j, Pedro D. Salinas, MD l, Vladyslav Dieiev, MD l, Michael Y. Woo, MD m, Rajiv Thavanathan, MD m, Graeme Puskas, BSc m, Karan Singh, MBBS n, Priyanka Bhat, MBBS n, Jackson Horn, BS o, Brian M. Buchanan, MD, MMEd p, Nadia Baig, BSc p, Katharine M. Burns, MD q, r, Kelsey Kennedy, MD q, Lawrence Haines, MD, MPH s, Leily Naraghi, MD s, Harpriya Singh, MD s, Michael Secko, MD t, Daniel Singer, MD t, Maria Taylor, RN, BSN t, John M. Joyce, MD u, Stephanie DeMasi, MD u, Zan M. Jafry, MD v, Tammy Phan, MD v, Natalie Truong, MD v, Evan Robinson, DO w, Korbin H. Haycock, MD x, Allyson Hansen, DO y, Charlotte Derr, MD y, Frances M. West, MD z, Mangala Narasimhan, DO aa, James Horowitz, MD cc, Asad Usman, MD, MPH dd, Kenton L. Anderson, MD ee, Yifan Peng, PhD ff, Philippe Rola, MD gg, Phillip Andrus, MD bb, Junaid Razzak, MD, PhD a, Hugh C. Hemmings, MD, PhD b, Rohan Panchamia, MD b, Joanna Palasz, MD a, Aarthi Kaviyarasu, BS hh, Nathaniel A. Sands, MPH hh, Robert M. Sutton, MD, MSCE ii, Benjamin S. Abella, MD, MPhil hhOn behalf of the
Resuscitative TEE Collaborative Registry (rTEECoRe) Investigators
a Department of Emergency Medicine, Weill Cornell Medicine, New York, NY
b Department of Anesthesiology, Weill Cornell Medicine, New York, NY
c Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY
d Division of Critical Care, Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM
e Department of Emergency Medicine, Kaweah Health, Visalia, CA
f Department of Emergency Medicine Sacred Heart Hospital of Montréal, Montréal, QC, Canada
g Department of Emergency Medicine University Hospital Careggi, Florence, FI, Italy
h Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
i Department of Emergency Medicine, London Health Sciences Centre, London, ON, Canada
j Medicine, London Health Sciences Centre, London, ON, Canada
k Division of Critical Care Medicine, Western University, London, ON, Canada
l Aurora Critical Care Services, Aurora St. Luke’s Medical Center, Milwaukee, WI
m Department of Emergency Medicine The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
n Department of Medicine, Medical Center of Bowling Green, Bowling Green, KY
o Western Kentucky Heart and Lung Research Foundation, Medical Center of Bowling Green, Bowling Green, KY
p Department of Critical Care Medicine University of Alberta Hospital, Edmonton, AB, Canada
q Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL
r Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL
s Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
t Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY
u Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA
v Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA
w Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
x Department of Emergency Medicine, Riverside University Health System, Moreno Valley, CA
y Department of Emergency Medicine, University of South Florida, Tampa, FL
z Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
aa Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
bb Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
cc Department of Medicine, New York University Langone Health, New York, NY
dd Department of Anesthesiology, University of Pennsylvania, Philadelphia, PA
ee Department of Emergency Medicine, Stanford University Hospital, Palo Alto, CA
ff Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
gg Intensive Care Unit, Santa Cabrini Hospital, Montréal, QC, Canada
hh Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
ii Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA
∗Corresponding Author.
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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| Please see page 148 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: William R. Mower, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: FT, CGO, RA, KB, FMW, MN, JH, KA, AU, and BSA conceived the study. All authors contributed significantly to the refinement of the study design and to the process of study implementation. FT, AK, NAS, and BSA undertook the recruitment of participating sites and oversaw the process of data collection. All authors contributed substantially to data collection and interpretation of data analysis. FT and BSA drafted the manuscript, and all authors contributed substantially to revisions and the final version of manuscript. FT takes responsibility for the manuscript as a whole. |
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| Data sharing statement: Partial or complete datasets and the data dictionary are available from the date of publication on request subject to approval by the Resuscitative TEE Collaborative Registry (rTEECoRe) Investigators’ Scientific Oversight Committee. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). Dr. Teran reports funding by National Institutes of Health (NIH) / National Heart, Lung and Blood Institute (NHLBI) K23 HL165150. FT is the owner of ResusMedx, LLC. BSA has ownership of VOC Health, MDAlly. FT, JEH, RA, and ZMJ have received consulting honoraria from Fujifilm Sonosite. RA has received consulting honoraria from Phillips Ultrasound. PDS has received consulting honoraria from General Electric Ultrasound and Echonous Ultrasound. BSA has received consulting honoraria from Becton Dickson, Zoll, and Stryker. KS has received honoraria from the American College of Chest Physicians. HCH is the editor in chief of the British Journal of Anaesthesia. FT, CGO, RA, RP, PDS, VD, KMB, JMJ, ZMJ, KLA, and PA are course faculty at the Resuscitative TEE Workshop. There is no relationship between this work and any activities with these entities. |
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© 2024
American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 85 - N° 2
P. 147-162 - février 2025 Retour au numéro
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