Precision Cardiac Care

Kenton Anderson, MD, and a national collaborative of transesophageal echocardiography (TEE) experts pioneer the use of TEE during cardiac arrest, providing real-time images of the heart’s aortic valve.

During cardiac arrest, one predictor for positive patient outcomes is the opening and closing of the aortic valve, signifying forward blood flow. However, chest compressions performed in the traditional center of the chest location frequently keep the aortic valve closed, which could do more harm than good.

Enter transesophageal echocardiography (TEE). In TEE, physicians insert an ultrasound probe into a patient’s esophagus to obtain images of the heart while the patient is in cardiac arrest, enabling them to see if the aortic valve is opening. TEE images are much simpler to obtain during ongoing chest compressions than traditional transthoracic echo images, are usually much higher quality, and are not impeded by defibrillation pads and other ongoing procedures.

Anderson, associate professor of emergency medicine, served as principal investigator for a national collaborative of 12 emergency medicine and critical care TEE experts who developed and released a mastery learning checklist for TEE training in cardiac arrest. Anderson also helped implement the use of TEE in cases of cardiac arrest at Stanford University’s Marc and Laura Andreessen Emergency Department and developed training modules and tools for attendings and residents.

Anderson credits Stanford’s Center for Immersive Simulation-based Learning (CIGH) facility for offering state-of-the-art simulations that enable faculty and residents to achieve certification. Unlike most ultrasound training where healthy volunteers can be used to teach scanning, TEE training requires that the patient — or a simulator — be in active cardiac arrest.

Incorporating TEE required collaborative efforts across different departments to address issues such as equipment cleaning, secure storage of hospital scans, training for attending physicians, residents, and nurses, and establishing coding.


Updated Spring 2024