Dr. Sara Nikravan, a leading cardiothoracic anesthesia critical care physician, discusses the groundbreaking role of transesophageal echocardiography (TEE) in cardiac emergencies. She highlights TEE's superior imaging capabilities over traditional methods for assessing cardiac function during critical situations. The importance of high-fidelity simulation training and timely interventions is emphasized, aiming to improve outcomes in resuscitation efforts. Dr. Nikravan also addresses the gaps in research on TEE’s impact in ICU settings and the need for enhanced training protocols for clinicians.
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TEE's Imaging Superiority Over TTE
Transesophageal echocardiography (TEE) offers clearer, higher resolution imaging in critically ill patients compared to transthoracic echo (TTE).
It is especially useful when surface imaging is limited by factors like trauma, lung hyperinflation, or open chest scenarios.
insights INSIGHT
TEE Reveals Hidden Diagnoses
TEE often reveals unexpected diagnoses missed by transthoracic echo in about 40% of cases.
It provides meaningful clinical information in about half of mechanically ventilated ICU patients.
volunteer_activism ADVICE
Use TEE Boldly in Arrest
In cardiac arrest, the risk of TEE complications is outweighed by the potential to save the patient's life.
Don't let fear of causing harm prevent you from using TEE in resuscitation efforts.
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Written by Kahlil Gibran, 'The Prophet' is a book of prose poetry that explores themes such as love, marriage, children, giving, eating and drinking, work, joy and sorrow, and more. The story follows the prophet Almustafa, who, before departing from the city of Orphalese, shares his wisdom with the people on a range of subjects. The book emphasizes the importance of freedom, self-knowledge, and the interconnectedness of all life. It has been widely acclaimed for its profound insights and has been translated into over 100 languages, making it one of the most translated books in history.
In this episode, Dr. Sergion Zanotti discusses TEE in cardiac arrest and shock. Critical care clinicians commonly utilize transthoracic echocardiography in the ICU as part of their point-of-care-ultrasonography (POCUS) toolkit. However, there is a growing push to train intensivists in using transesophageal echocardiography (TEE) for cardiac arrest and peri-arrest situations in the ICU. Our guest is Dr. Sara Nikravan, a cardiothoracic anesthesia critical care physician with training in advanced perioperative echocardiography. Dr. Nikravan is an Associate Professor of Cardiothoracic Anesthesiology and Critical Care Medicine at the University of Washington Medical School and practices at the UW Medical Center. She is recognized as an expert and master educator in Critical Care, Perioperative echocardiography, and Point of Care Ultrasound. She has authored numerous peer-reviewed papers and is the guidelines co-chair of the Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024, recently published in Critical Care Medicine.
Additional links:
Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024, Crit Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/39982182/
Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. JACC 2020: https://pubmed.ncbi.nlm.nih.gov/32762909/
Landing page for the Resuscitative TEE Project website: https://www.resuscitativetee.com/
Books mentioned in this episode:
The Prophet. By Kahlil Gibran: https://www.amazon.com/dp/998247037X?psc=1&smid=ATVPDKIKX0DER&ref_=chk_typ_imgToDp
Critical Matters 