Utility of telemedicine 3d transesophageal echocardiography in interventional procedures in covid-19 pandemic and its impact on physician learning

ABSTRACT

Background: Three-dimensional transesophageal echocardiography (3DTEE) is a diagnostic tool in cardiac procedures, but COVID-19 has made utility challenging. Training junior (JR) attendings and fellows in 3DTEE guidance cases in procedural rooms make it tough to maintain adequate social distance. Collaboration Live (CL) is an application on the ultrasound machine that allows for live communication and access to real time images with a remote user. The study aims were to assess the usefulness of CL during 3DTEE guided procedures and its impact on physician learning. Methods: 3DTEE was obtained in 8 cohorts ranging 4-52 years of age on the EPIQ ultrasound machine. CL was used in transcatheter atrial/ventricular septal defect closures, transvenous pacemaker lead placement, and Fontan fenestration closure. 3DTEE was directed by a senior (SR) 3D attending over CL at a remote workstation while a JR attending, cardiac fellow, and echocardiographer performed 3DTEE in the procedural room. A CL post survey was given. Wait time from received page to the start of TEE, TEE duration, fluoroscopy time, absorbed X-ray dose, and saved amount of personal protective equipment (PPE) was noted. Results: A JR attending was in 8/8 cases. CL decreased reliance on SR attending and improved independence in 86% of cases, and no change in 14%. A fellow was in 6/8 cases. CL decreased reliance on SR 3D attending and increased independence in 67% of cases, and no change in 33%. A SR attending was remotely present in all cases. CL allowed flexibility for SR attending in 89% of cases and no flexibility in 11%. Preferred learning skill, comfort performing/giving results over CL, learning/teaching impact, remote user wait time, reduced radiation exposure, and saved amount of PPE are shown in Table 1. Conclusions: CL is valuable in 3DTEE guidance procedures. It increases cost savings by reducing PPE and promotes learner independence. CL allows flexibility and reduces radiation exposure for remote users.