Implementation of Resuscitative Transesophageal Echocardiography to Improve Cardiac Arrest Outcomes (MAINSTREAM): 6-Month Outcomes

We conducted a time interrupted series design study using a TEE simulator. We included residency graduates with basic echo credentials and excluded EPs with prior TEE training. We assessed skill using a recognized 10 item rTEE checklist requiring demonstration of probe handling (omniplane use; flexion and lateral probe movement) and production of mid-esophageal (ME) 4 chamber (ME4C), ME long axis (MELA), and transgastric (TG) windows. Trainees identified the atria, ventricles, mitral and aortic valves. A baseline assessment followed by 5 coached attempts occurred twice in 2 weeks. At 6 months, participants repeated the assessment. Trained assessors judged checklist component completion. Decay was evaluated using a binary checklist summarized at the item and trainee levels. Additional decay measures included probe distance manipulation and time to obtain adequate windows. Changes in binary items were assessed using McNemar’s test. We summarized paired differences using means and 95% CIs. Given the small sample size and ceiling effects, results were interpreted descriptively with emphasis on magnitude and direction of change.

Resuscitative transesophageal echo (rTEE) is uncommonly practiced, technical, and prone to decay. Our objective was to measure rTEE skill decay 6 months after completing a competency-based simulation training program.

Fourteen trainees completed both assessments. Baseline performance was 98% (137/140 items) declining to 91% (127/140) at follow up. Item-level losses occurred in obtaining TG, MELA, ME4C views while other items remained stable. McNemar’s tests did not demonstrate significant asymmetry in item-level changes. At the trainee level, mean checklist performance declined from 9.8 to 9.1 items (mean difference −0.7; 95% CI −1.5 to 0.1). Seven trainees (50%) lost at least one item, six showed no change, and one improved. Mean time to obtain views increased from 116 to 225 seconds (mean difference +108 seconds; 95% CI 63 to 153), and mean probe distance increased from 73 to 123 cm (mean difference +51; 95% CI 19 to 82). All trainees demonstrated increased time to view, and 78.6% showed increased probe distance.

rTEE skill is prone to decay at 6-months following structured simulation sessions suggesting frequent retraining may be necessary for sustained competency.