Impact of Simulator-based Training in Transoesophageal Echocardiography
Condition: Imaging of Heart Disease
MeSH terms: Heart Diseases
Study type: Observational

Summary: 
      The investigators would like to evaluate how well intensive care trainees without previous
      experience in transesophageal echocardiography are able to perform a transesophageal
      echocardiography study in the clinical setting after completing a simulator based training
      compared to conventional training.
    

Detailed description: 
      Background

      Echocardiography is currently the sole imaging modality at the bedside that provides
      real-time information on cardiac anatomy and function. Echocardiography is increasingly used
      in the intensive care unit (ICU) setting for the focussed hemodynamic assessment of patients
      with cardiorespiratory compromise. The principal role for focussed echocardiography is the
      time-sensitive assessment of the symptomatic patient. This evaluation primarily includes the
      assessment for pericardial effusion, the evaluation of relative chamber size, global cardiac
      and valvular function and patient volume status. The clinical impact of echocardiography for
      the treatment of critically ill patients with hemodynamic compromise is well documented and
      increasing general consensus exists, that all physicians in charge of critically ill patients
      should be trained in focussed echocardiography. Accordingly there is an urgent need for
      specific training in echocardiography.

      Transoesophageal echocardiography (TOE) is besides transthoracic echocardiography (TTE) the
      main imaging modality in the ICU setting. TTE image quality is often compromised by lung
      inflation in ventilated patients or by the presence of dressings or drains in locations used
      for image acquisition. It thus seems reasonable to suggest that every critical care physician
      should be able to perform a focused TOE. However, a multitude of barriers continue to limit
      TOE training including time constraints in busy ICUs, limited number of appropriate cases and
      a lack of experienced teaching faculty. Proficiency in TOE image acquisition requires
      in-depth knowledge of three-dimensional cardiac anatomy and repetitive supervised hands-on
      experience to develop the necessary manual skills. Typically TOE skill acquisition occurs in
      real time in the ICU while caring for a patient, thus the time that can be devoted to
      training is limited. However, using a semi-invasive imaging modality in ICU patients for
      training solely for training purposes is problematic due to the associated (minimal) risks
      and patient discomfort. Recently commercially available TOE simulation systems have been
      introduced. These systems allow for patient-independent training of TOE skills using
      simulations of the human heart. When used as an educational adjunct standardized TOE
      simulation training in a virtual reality environment may lead to a more rapid development of
      psychomotor skills. TOE simulators also offer the possibility to simulate pathological
      conditions of the heart and thus may facilitate training in image interpretation.

      The purpose of this study is to determine the effectiveness of a simulator based TOE training
      curriculum to train all necessary components of focused critical care echocardiography in
      accordance with the basic perioperative transesophageal examination as defined by the
      American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.
      This includes the psychomotor skills necessary for obtaining echocardiographic images of
      sufficient quality according to established quality scoring systems and the ability of
      recognizing the relevant anatomic structures as well as image interpretation when evaluating
      a hemodynamically compromised patient.

      Objective

      To evaluate the effect of a simulator in the training for transesophageal echocardiography

      Methods

      The investigators will perform a prospective, observational trial investigating the impact of
      simulator TOE training in novice operators on quality of imaging, correct image
      interpretation and resource use when performing a focussed TOE examination in ICU patients.
      Forty-fife ICU trainees without previous hands-on echocardiography skills will undergo a
      formal training consisting of 4 hours of theoretical instructions including basics of
      transesophageal echocardiography, cardiac anatomy, standard views as well as physiology and
      pathophysiology. Instructions will be provided by expert TOE operators. 30 of these trainees
      will additionally be trained using the HeartWorks TOE simulator. This training consists of 4
      sessions of supervised practice using the TOE simulator.

      After conclusion of the training program the trainees will perform one basic perioperative
      echocardiography study using the HeartWorks TOE simulator and two basic perioperative
      echocardiography studies in real ICU patients.
    

Intervention name(s): Transesophageal echocardiography simulator
Intervention type(s): Device
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Trainees in critical care
      
Keywords: Simulator in transesophageal echocardiography