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Arango S, Gorbaty B, Buyck D, Johnson J, Porter ST, Iaizzo PA, Perry TE. A Free-Access Online Interactive Simulator to Enhance Perioperative Transesophageal Echocardiography Training Using a High-Fidelity Human Heart 3D Model. J Cardiothorac Vasc Anesth 2023; 37:308-313. [PMID: 36372718 DOI: 10.1053/j.jvca.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
The clinical uses of perioperative transesophageal echocardiography have grown exponentially in recent years for both cardiac and noncardiac surgical patients. Yet, echocardiography is a complex skill that also requires an advanced understanding of human cardiac anatomy. Although simulation has changed the way echocardiography is taught, most available systems are still limited by investment costs, accessibility, and qualities of the input cardiac 3-dimensional models. In this report, the authors discuss the development of an online simulator using a high-resolution human heart scan that accurately represents real cardiac anatomies, and that should be accessible to a wide range of learners without space or time limitations.
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Affiliation(s)
- Susana Arango
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN; The Visible Heart Laboratories, Department of Surgery, Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN.
| | - Benjamin Gorbaty
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
| | - David Buyck
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - James Johnson
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - Samantha T Porter
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - Paul A Iaizzo
- The Visible Heart Laboratories, Department of Surgery, Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN
| | - Tjörvi E Perry
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
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Chahal N, Feinman J. Welcome to the Machine: The Role of Online Simulation in TEE Training. J Cardiothorac Vasc Anesth 2023; 37:314-315. [PMID: 36473762 DOI: 10.1053/j.jvca.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Navdeep Chahal
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jared Feinman
- Hospital of the University of Pennsylvania, Philadelphia, PA.
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Arango S, Gorbaty B, Tomhave N, Shervheim D, Buyck D, Porter ST, Iaizzo PA, Perry TE. A High-Resolution Virtual Reality-Based Simulator to Enhance Perioperative Echocardiography Training. J Cardiothorac Vasc Anesth 2023; 37:299-305. [PMID: 36229288 DOI: 10.1053/j.jvca.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/13/2022] [Accepted: 09/02/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Susana Arango
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN; The Visible Heart Laboratories, Department of Surgery, Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN.
| | - Benjamin Gorbaty
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
| | - Nicholas Tomhave
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
| | - Daniel Shervheim
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - David Buyck
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - Samantha T Porter
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - Paul A Iaizzo
- The Visible Heart Laboratories, Department of Surgery, Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN
| | - Tjörvi E Perry
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
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Variable exposure to echocardiography core competencies when applying minimum recommended procedural numbers for cardiology fellows in training. Cardiovasc Ultrasound 2022; 20:24. [PMID: 36123701 PMCID: PMC9487095 DOI: 10.1186/s12947-022-00294-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The American College of Cardiology Core Cardiovascular Training Statement (COCATS) defined echocardiography core competencies and set the minimum recommend number of echocardiograms to perform (150) and interpret (300) for independent practice in echocardiography (level 2 training). Fellows may lack exposure to key pathologies that are relatively infrequent, however, even when achieving an adequate number of studies performed and interpreted. We hypothesized that cardiology fellows would lack exposure to 1 or more cardiac pathologies related to core competencies in COCATS when performing and interpreting the minimum recommend number of studies for level 2 training. Methods We retrospectively reviewed 11,250 reports from consecutive echocardiograms interpreted (7,500) and performed (3,750) by 25 cardiology fellows at a University tertiary referral hospital who graduated between 2015 and 2019. The first 300 echocardiograms interpreted and the first 150 echocardiograms performed by each fellow were included in the analysis. Echocardiography reports were reviewed for cardiac pathologies relating to core competencies defined in COCATS. Results All 25 fellows lacked exposure to 1 or more cardiac pathologies related to echocardiography core competencies despite meeting COCATS minimum recommended numbers for echocardiograms performed and interpreted. Pathologies for which 1 or more fellows encountered 0 cases despite meeting the minimum recommended numbers for both echocardiograms performed and interpreted included: pericardial constriction (16/25 fellows), aortic dissection (15/25 fellows), pericardial tamponade (4/25 fellows), valvular mass/thrombus (2/25 fellows), prosthetic valve dysfunction (1/25 fellows), and cardiac chamber mass/thrombus (1/25 fellows). Conclusions Cardiology fellows who completed the minimum recommend number of echocardiograms performed and interpreted for COCATS level 2 training frequently lacked exposure to cardiac pathologies, even in a University tertiary referral hospital setting. These data suggest that fellowship programs should monitor pathology case counts for each fellow in training, in addition to the minimum recommend number of echocardiograms defined by COCATS, to ensure competency for independent practice in echocardiography.
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Sawasdiwipachai P, Thanasriphakdeekul S, Raksamani K, Vacharaksa K, Chaithiraphan V. Learning curve for the acquisition of 20 standard two-dimensional images in advanced perioperative transesophageal echocardiography: a prospective observational study. BMC MEDICAL EDUCATION 2022; 22:412. [PMID: 35637456 PMCID: PMC9153196 DOI: 10.1186/s12909-022-03280-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/22/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Learning to perform intraoperative transesophageal echocardiography takes time and practice. We aimed to determine the cumulative success rate in the first 20 intraoperative transesophageal echocardiography cases performed by trainee anesthesiologists with no transesophageal echocardiography experience. METHODS This prospective observational study included nine anesthesiologists (four cardiovascular and thoracic anesthesia fellows and five short-course perioperative intraoperative transesophageal echocardiography trainees). Overall, 180 studies self-performed by the trainees were reviewed by certified reviewers. A study was considered successful when at least 15 qualified images were collected within 30 min. The cumulative success of each trainee was used as a surrogate of a basic two-dimensional intraoperative transesophageal echocardiography learning curve. RESULTS The participants comprised three male and six female anesthesiologists aged 29-43 years with 2-13 years of work experience. Most studies (146/180, 81.11%) were completed within 30 min, and the cumulative success rate was 70-90% (average 82.78 ± 6.71%). The average cumulative success rate in the short-course group (85 ± 7.07%) was higher than that in the official cardiovascular and thoracic fellow trainee group (80 ± 7.07%). The recommended caseload for a 80-100% success rate was 18-20 cases (95% confidence interval, 0.652-0.973). The CUSUM method analysis confirmed that the lower decision limit was crossed after 20 TEE studies among those achieved competence. CONCLUSIONS We recommended a 18-20 caseload for a target success rate of 80-100% in studies performed by trainees with no previous experience. Our findings will enable the development of programs to train anesthesiologists in intraoperative transesophageal echocardiography.
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Affiliation(s)
- Prasert Sawasdiwipachai
- Anesthesiology Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sasithorn Thanasriphakdeekul
- Department of Anesthesiology, Khon Kaen Hospital, 54 Sri Chant Rd, Nai Meuang, Meuang Khon Kaen District, Khon Kaen, 40000, Thailand
| | - Kasana Raksamani
- Anesthesiology Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Kamheang Vacharaksa
- Anesthesiology Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Vithaya Chaithiraphan
- Her Majesty Cardiac Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Meineri M, Menon P, Ender J, Forner A. Impact of a one-day three-dimensional transesophageal echocardiography workshop on clinical practice at a single academic centre. Ann Card Anaesth 2022; 25:479-484. [DOI: 10.4103/aca.aca_97_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Meineri M, Arellano R, Bryson G, Arzola C, Chen R, Collins P, Denault A, Desjardins G, Fayad A, Funk D, Hegazy AF, Kim H, Kruger M, Kruisselbrink R, Perlas A, Prabhakar C, Syed S, Sidhu S, Tanzola R, Van Rensburg A, Talab H, Vegas A, Bainbridge D. Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres. Can J Anaesth 2020; 68:376-386. [DOI: 10.1007/s12630-020-01867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022] Open
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Vignon P, Pegot B, Dalmay F, Jean-Michel V, Bocher S, L'her E, Cros J, Prat G. Acceleration of the learning curve for mastering basic critical care echocardiography using computerized simulation. Intensive Care Med 2018; 44:1097-1105. [PMID: 29931488 DOI: 10.1007/s00134-018-5248-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/26/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the impact of computerized transthoracic echocardiography (TTE) simulation on the learning curve to achieve competency in basic critical care echocardiography (CCE). METHODS In this prospective bicenter study, noncardiologist residents novice in ultrasound followed either a previously validated training program with adjunctive computerized simulation on a mannequin (two 3 h-sessions; Vimedix simulator, CAE Healthcare) (interventional group; n = 12) or solely the same training program (control group; n = 12). All trainees from the same institution were assigned to the same study group to avoid confusion bias. Each trainee was evaluated after 1 (M1), 3 (M3) and 6 (M6) months of training using our previously validated scoring system. Competency was defined by a score ≥ 90% of the maximal value. RESULTS The 24 trainees performed 965 TTE in patients with cardiopulmonary compromise during their 6-month rotation. Skills assessments relied on 156 TTE performed in 106 patients (mean age 53 ± 14 years; mean Simplified Acute Physiologic Score 2: 55 ± 19; 79% ventilated). When compared to the control group, trainees of the interventional group obtained a significantly higher mean skills assessment score at M1 (41.5 ± 4.9 vs. 32.3 ± 3.7: P = 0.0004) and M3 (45.8 ± 2.8 vs. 42.3 ± 3.7: P = 0.0223), but not at M6 (49.7 ± 1.2 vs. 50.0 ± 2.7: P = 0.6410), due to higher practical and technical skills scores. Trainees of the control group required significantly more supervised TTE to obtain competency than their counterparts (36 ± 7 vs. 30 ± 9: p = 0.0145). CONCLUSIONS Adjunctive computerized simulation accelerates the learning curve of basic CCE in improving practical and technical skills and reduces the number of TTE examinations required to reach competency.
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Affiliation(s)
- Philippe Vignon
- Medical-surgical ICU, Dupuytren Teaching Hospital, Limoges, France. .,INSERM CIC 1435, Dupuytren Teaching Hospital, Limoges, France. .,University of Limoges, Limoges, France. .,Réanimation Polyvalente, CHU Dupuytren, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France.
| | - Benjamin Pegot
- Medical-surgical ICU, Dupuytren Teaching Hospital, Limoges, France
| | - François Dalmay
- INSERM, UMR 1094, Dupuytren Teaching Hospital, Limoges, France
| | | | | | - Erwan L'her
- Medical ICU, Teaching Hospital, Brest, France.,INSERM, UMR 1101, University of Bretagne Occidentale, Brest, France.,CESIM santé, FHU TechSan, University of Bretagne Occidentale, University of Rennes, Brest, France
| | - Jérôme Cros
- Anesthesiology Department, Dupuytren Teaching Hospital, Limoges, France
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Core point-of-care ultrasound curriculum: What does every anesthesiologist need to know? Can J Anaesth 2018; 65:417-426. [DOI: 10.1007/s12630-018-1063-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023] Open
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Callison SAR, Gannon I, Zisblatt L. Introductory Experience in Transesophageal Echocardiography for Anesthesiology Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10666. [PMID: 30800867 PMCID: PMC6342386 DOI: 10.15766/mep_2374-8265.10666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/30/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Transesophageal echocardiography (TEE) has become an important imaging modality for anesthesiologists to monitor and identify major cardiothoracic pathology in both noncardiac and cardiac surgical patients during the perioperative period. Knowledge in basic TEE sonoanatomy and the ability to obtain 11 basic views is a necessary foundation for junior residents so they may focus on using TEE as a monitor and tool to identify major cardiothoracic pathology later in their training. METHODS The purpose of the rotation is to introduce TEE image acquisition to clinical anesthesia Year 1 (CA-1) and CA-2 residents. In this module, the anesthesiology resident is assigned to a specific TEE-week rotation in the cardiovascular center. There are three main components to our TEE curriculum: (1) web-based and simulator-based exposure to image acquisition and sonoanatomy, (2) intraoperative exposure to image acquisition and sonoanatomy, and (3) the 11 standard basic TEE views worksheet and assessment tool. RESULTS Using the 11 standard basic TEE views assessment tool, 100% of the residents who went through the curriculum were able to obtain at least nine of the 11 views without prompting. Forty-five percent (n = 5) of CA-1 were able to obtain all 11 views without prompting, while 58% of the CA-2s were able to obtain all 11 views without prompting. DISCUSSION The preliminary results from our TEE curriculum are promising. We hope that this early exposure will lead to better learning on the residents' cardiac rotations in the CA-2 and CA-3 years by allowing them to start recognizing major pathology on TEE early on.
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Affiliation(s)
| | - Ian Gannon
- Assistant Professor, Department of Anesthesiology, University of Michigan Health System
| | - Lara Zisblatt
- Educational Specialist, Department of Anesthesiology, University of Michigan Health System
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Nazarnia S, Subramaniam K. Role of Simulation in Perioperative Echocardiography Training. Semin Cardiothorac Vasc Anesth 2016; 21:81-94. [PMID: 27381621 DOI: 10.1177/1089253216655874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Echocardiography plays a major role in the diagnosis and management of hemodynamic compromise during the perioperative period. Both transthoracic and transesophageal echocardiography have been shown to improve outcomes after cardiac and noncardiac surgery. Teaching basic echocardiographic skills to perioperative physicians remains a challenging task. Thus far, simulation-based medical education has been proven useful in teaching specific procedural skills and management of infrequent catastrophic events. Simulation-based echocardiography education has the potential to facilitate clinical training in echocardiography. Several small studies have shown the benefits of echocardiographic simulation on developing psychomotor and cognitive echocardiography skills. Future research should focus on the impact of simulation on actual clinical echocardiographic performance in the operating room and ultimately, patient outcomes.
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Prat G, Charron C, Repesse X, Coriat P, Bailly P, L'her E, Vieillard-Baron A. The use of computerized echocardiographic simulation improves the learning curve for transesophageal hemodynamic assessment in critically ill patients. Ann Intensive Care 2016; 6:27. [PMID: 27055668 PMCID: PMC4824699 DOI: 10.1186/s13613-016-0132-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/21/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Our aim was to evaluate the impact of a computerized echocardiographic simulator on the learning curve for transesophageal echocardiography (TEE) hemodynamic assessment of ventilated patients in the ICU. METHODS We performed a prospective study in two university hospital medical ICUs. Using our previously validated skill assessment scoring system (/40 points), we compared learning curves obtained with (interventional group, n = 25 trainees) and without (control group, n = 31 trainees) use of a simulator in the training. Three evaluations were performed after 1 (M1), 3 (M3) and 6 months (M6) while performing two TEE examinations graded by an expert. Competency was defined as a score >35/40. RESULTS Competency was achieved after an average of 32.5 ± 10 supervised studies in the control group compared with only 13.6 ± 8.5 in the interventional group (p < 0.0001). At M6, a significant between-group difference in number of supervised TEE was observed (17 [14-28] in the control group vs. 30.5 [21.5-39.5] in the interventional group, p = 0.001). The score was significantly higher in the interventional group at M1 (32.5 [29.25-35.5] vs. 24.75 [20-30.25]; p = 0.0001), M3 (37 [33.5-38.5] vs. 32 [30.37-34.5]; p = 0.0004), but not at M6 (37.5 [33-39] vs. 36 [33.5-37.5] p = 0.24). CONCLUSION Inclusion of echocardiographic simulator sessions in a standardized curriculum may improve the learning curve for hemodynamic evaluation of ventilated ICU patients.
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Affiliation(s)
- Gwénaël Prat
- Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France. .,Centre de Simulation en Santé, Université de Bretagne Occidentale, Brest, France.
| | - Cyril Charron
- Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France
| | - Xavier Repesse
- Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France
| | - Pierre Coriat
- Hospital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie-Curie-Paris 6, Paris, France
| | - Pierre Bailly
- Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France.,Centre de Simulation en Santé, Université de Bretagne Occidentale, Brest, France
| | - Erwan L'her
- Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France.,LATIM INSERM UMR 1101, Université de Bretagne Occidentale, Brest, France.,FHU TechSan, Université de Bretagne Occidentale/Université de Rennes, Rennes, France
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France.,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94807, Villejuif, France
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Expanding role of perioperative transesophageal echocardiography in the general anesthesia practice and residency training in the USA. Curr Opin Anaesthesiol 2015; 28:95-100. [DOI: 10.1097/aco.0000000000000146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ramakrishna H, Kohl BA, Gutsche JT, Fassl J, Patel PA, Riha H, Ghadimi K, Vernick WJ, Andritsos M, Silvay G, Augoustides JGT. The year in cardiothoracic and vascular anesthesia: selected highlights from 2013. J Cardiothorac Vasc Anesth 2014; 28:1-7. [PMID: 24440007 DOI: 10.1053/j.jvca.2013.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Indexed: 12/16/2022]
Abstract
This article reviewed selected research highlights of 2013 that pertain to the specialty of cardiothoracic and vascular anesthesia. The first major theme is the commemoration of the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance. The second major theme is the diffusion of echocardiography throughout perioperative practice. There are now guidelines and training pathways to guide its generalization into everyday practice. The third major theme is the paradigm shift in perioperative fluid management. Recent large randomized trials suggest that fluids are drugs that require a precise prescription with respect to type, dose, and duration. The final theme is patient safety in the cardiac perioperative environment. A recent expert scientific statement has focused attention on this issue because most perioperative errors are preventable. It is likely that clinical research in this area will blossom because this is a major opportunity for improvement in our specialty. The patient care processes identified in these research highlights will further improve perioperative outcomes for our patients.
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Affiliation(s)
- Harish Ramakrishna
- Assistant Professor, Director of Cardiac Anesthesia, Mayo Clinic, Scottsdale, AZ
| | - Benjamin A Kohl
- Assistant Professor, Director of Critical Care, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Assistant Professor, Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jens Fassl
- Assistant Professor, Cardiovascular and Thoracic Section, Department of Anesthesia and Intensive Care Medicine, University of Basel, Basel, Switzerland
| | - Prakash A Patel
- Assistant Professor, Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Clinical Assistant Professor, Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Kamrouz Ghadimi
- Senior Fellow, Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William J Vernick
- Assistant Professor, Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Andritsos
- Clinical Associate Professor, Director of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, Ohio State University, Columbus, OH
| | - George Silvay
- Professor, Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G T Augoustides
- Assistant Professor, Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Teistler M, Brunberg JA, Bott OJ, Breiman RS, Ebert LC, Ross SG, Dresing K. Understanding spatial relationships in US: a computer-based training tool that utilizes inexpensive off-the-shelf game controllers. Radiographics 2014; 34:1334-43. [PMID: 25110963 DOI: 10.1148/rg.345130039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors present a simulation-based ultrasonographic (US) training tool that can help improve the understanding of spatial relationships in US. Use of a game controller to simulate a US probe allows examination of different virtual three-dimensional (3D) objects. These 3D objects are either completely artificial simple geometric objects (eg, spheres, tubes, and ellipsoids, or more complex combinations thereof) or derived from photographed gross anatomic data (eg, the Visible Human dataset [U.S. National Library of Medicine]) or clinical computed tomographic (CT) data. The virtual US probe allows infinitely variable real-time positioning of a "slice" that is displayed as a two-dimensional (2D) cross-sectional image and as part of a 3D view. Combining the 2D and 3D views helps elucidate the spatial relationships between a 3D object and derived 2D images. This training tool provides reliable real-time interactivity and is widely available and easily affordable, since it utilizes standard personal computer technology and off-the-shelf gaming hardware. For instance, it can be used at home by medical students or residents as a complement to conventional US training. In the future, this system could be adapted to support training for US-guided needle biopsy, with use of a second game controller to control the biopsy needle. Furthermore, it could be used as a more general interactive visualization tool for the evaluation of clinical 3D CT and magnetic resonance imaging data, allowing efficient and intuitive real-time creation of oblique multiplanar reformatted images.
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Affiliation(s)
- Michael Teistler
- From the Faculty of Information and Communication, Flensburg University of Applied Sciences, Kanzleistrasse 91-93, 24943 Flensburg, Germany (M.T.); Department of Radiology, UC Davis, Sacramento, Calif (J.A.B.); Department of Information and Communication, Faculty III, Hannover University of Applied Sciences and Arts, Hannover, Germany (O.J.B.); Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, Calif (R.S.B.); Institute of Forensic Medicine, University of Zürich, Zürich, Switzerland (L.C.E., S.G.R.); and Department of Trauma Surgery, Plastic and Reconstructive Surgery, Georg August University Medical Center, Göttingen, Germany (K.D.)
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Sharma V, Fletcher SN. A review of echocardiography in anaesthetic and peri‐operative practice. Part 2: training and accreditation. Anaesthesia 2014; 69:919-27. [DOI: 10.1111/anae.12709] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 11/27/2022]
Affiliation(s)
- V. Sharma
- St George's University of London London UK
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Abstract
There has been a recent explosion of education and training in echocardiography in the specialties of anesthesiology and critical care. These devices, by their impact on clinical management, are changing the way surgery is performed and critical care is delivered. A number of international bodies have made recommendations for training and developed examinations and accreditations.The challenge to medical educators in this area is to deliver the training needed to achieve competence into already over-stretched curricula.The authors found an apparent increase in the use of simulators, with proven efficacy in improving technical skills and knowledge. There is still an absence of evidence on how it should be included in training programs and in the accreditation of certain levels.There is a conviction that this form of simulation can enhance and accelerate the understanding and practice of echocardiography by the anesthesiologist and intensivists, particularly at the beginning of the learning curve.
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Damp J, Anthony R, Davidson MA, Mendes L. Effects of transesophageal echocardiography simulator training on learning and performance in cardiovascular medicine fellows. J Am Soc Echocardiogr 2013; 26:1450-1456.e2. [PMID: 24055126 DOI: 10.1016/j.echo.2013.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The role of transesophageal echocardiography (TEE) simulation in cardiology fellows' learning is unknown. Standard TEE training at the authors' institution occurs during the second of 3 clinical years. Fellows spend 2 months in the TEE laboratory learning through hands-on experience. The addition of TEE simulation to this experience may improve proficiency, speed learning, and increase fellows' comfort with TEE. This study was designed to compare methods of TEE simulator training with standard training. METHODS Group A (n = 8) consisted of fellows who had completed standard TEE training. Fellows starting their second clinical year were randomly assigned to group B (n = 10), simulator training during month 1, or group C (n = 9), simulator training during month 2. All groups completed 2 months of standard TEE training. All groups underwent assessment of TEE performance and a self-assessment of ability and comfort level with TEE. RESULTS Groups B and C had higher total assessment scores than group A. Groups B and C had higher numbers of views achieved without assistance (P = .01). After month 1, group B had higher total scores and number of views achieved without assistance compared with group C (P = .02 and P = .02, respectively). The length of time of the examination tended to be lower for group B, and fellows in group B had greater comfort with TEE than those in group C (P = .01). CONCLUSIONS These data suggest that TEE simulator training improves proficiency and helps speed learning and comfort with TEE.
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Affiliation(s)
- Julie Damp
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Jelacic S, Bowdle A, Togashi K, VonHomeyer P. The Use of TEE Simulation in Teaching Basic Echocardiography Skills to Senior Anesthesiology Residents. J Cardiothorac Vasc Anesth 2013; 27:670-5. [DOI: 10.1053/j.jvca.2013.01.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Indexed: 11/11/2022]
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