Lecture presented at the 2016 Society of Academic Emergency Medicine Conference
held in New Orleans, USA, on May 11th, 2016.
"Focused transthoracic echocardiography (TTE) to determine prognosis and uncover reversible etiologies during resuscitation has been recommended by the American Heart Association and the International Liaison Committee on Resuscitation (ILCOR) guidelines. Additionally, TTE has allowed Emergency Physicians (EPs) to identify the subgroup of patients in whom the absence of cardiac activity predicts an extremely low chance of survival indicating that resuscitative efforts should be discontinued. The main limitation of TTE is the difficulty of obtaining adequate views due to anatomic and technical factors. Transesophageal echocardiography (TEE) provides numerous benefits compared to TTE and has been used by cardiologists and anesthesiologists to assess patients during hemodynamic decompensation and during resuscitation of cardiac arrest. While the 2008 ACEP Emergency Ultrasound Guidelines consider TEE as an emerging ultrasound application, several factors have precluded the widespread uptake of this intervention. These factors include cost of transducers, perceived risks and training difficulties. Eight years after this first report we believe we have achieved a point where we can provide effective solutions to all these issues in order to pioneer the advance of this application. Once considered part of the future of advanced resuscitation, TEE is today a reality, and has tremendous potential to improve resuscitation care. In the current presentation, I describe our experience at the Mount Sinai Resuscitative TEE program, a multidisciplinary collaboration that successfully implemented the use of TEE performed by Emergency Physicians. By sharing this experience, I aim to encourage and inspire others to join us in the advancement of this field."