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The Feasibility of Teaching Transthoracic Echocardiography to Anesthetists and Intensivists in a Low Resource Country
Abstract Number: S-48
Abstract Type: Original Research
Despite significant improvement worldwide since 1990, rates of maternal mortality remain exceedingly high. Ninety-nine percent of maternal deaths occur in developing countries, and over half of these deaths occur in sub-Saharan Africa. Many of these deaths, however, are preventable. Complications of hemorrhage and pregnancy-induced hypertension are the leading causes of maternal mortality. Intravascular volume assessment and fluid replacement remain challenging in these situations. A noninvasive means of assessing intravascular volume status and myocardial function may improve patient management. Transthoracic echocardiography (TTE) is being used successfully for acute patient care in the emergency department and in the surgical and medical intensive care units. Critically ill obstetric patients are an additional group who may benefit from bedside TTE. We sought to determine the feasibility of teaching basic bedside TTE to both anesthetists and intensivists in Ghana, Africa.
Nine anesthetists of various levels of experience and one intensivist volunteered to participate in a 2-hour TTE workshop which included a PowerPoint lecture followed by hands-on training using a portable Sonosite MicroMaxx Ultrasound System. Only one anesthetist had any prior exposure to TTE. A 31-question written pre-test was administered prior to attending the workshop; the same test was administered again after workshop completion. A skills test was also administered after completion of the workshop which involved each participant obtaining 5 basic transthoracic echocardiographic views on a volunteer subject. The views were assessed based on accuracy and quality of the images obtained.
All participants improved their written test score after completion of the workshop except for the participant with prior TTE exposure whose score remained unchanged. The ability of participants to obtain accurate TTE views after completion of the workshop was inconsistent as was the quality of images obtained.
After 2 hours of basic TTE training, all workshop participants with no prior TTE exposure improved their written post-test score. These results show that in a short period of time, basic knowledge of TTE can be obtained. However, the ability of participants to obtain accurate TTE images was inconsistent and did not correlate with written test score improvement. These results show that the application of the information learned during the TTE workshop did not translate into obtaining useful, practical images. We conclude that teaching the concepts of basic transthoracic echocardiography to anesthetists and intensivists in low resource countries is quite feasible. However, more instruction and hands-on teaching and experience are required before this new tool can be incorporated into daily use for obstetric patient care.