Utility of Simulation in Transthoracic and Transesophageal Echocardiogram-Based Training of a Cardiovascular Workforce in Low and Middle-Income Countries (LMIC)

Abstract

The second leading cause of mortality in the world is cardiovascular disease (CVD), causing 17 million deaths in 2013. CVD disproportionately affects low- and middle-income countries (LMIC), which account for 80% of these deaths. The use of ultrasound technology has been a mainstay in the medical field for formal diagnostic purposes for years and has recently received increased interest for point-of-care diagnostics and procedural guidance. Transesophageal echocardiography (TEE) is routinely used for diagnosis and monitoring during cardiac surgery, and transthoracic echocardiography (TTE) is increasingly used as a point-of-care diagnostic modality both in the perioperative setting and in critically ill patients. In recent years, there has been emergence of portable ultrasound devices that offer many of the functionalities of traditional ultrasound machines. These handheld portable ultrasound devices have been shown to be very effective as a diagnostic modality and are a promising technology for increasing adoption of ultrasound use in LMIC. Significant training and expertise is required to achieve a level of expertise needed to perform and interpret an echocardiographic examination. Traditional training with direct supervision of an experienced and certified practitioner is not practical for widespread adoption of echocardiography in LMIC. There is a range of simulators available in the market for replicating a TTE and TEE exams. These simulators give learners the added benefit of familiarizing themselves with echocardiography before application in a patient care setting. A variety of simulators are available in the market across various price points, each with its own benefits and limitations, from static simulation to 2D and 3D imaging, as well as AR capability. It is possible to develop curriculums that include simulators as part of the teaching to train learners in echocardiography. Such technology increases the number of possibilities for future applications and may help in the early diagnosis of deadly diseases such as RHD and CVD.KeywordsAnesthesiaCardiac surgeryCurriculumEchocardiographyImagingLow-income countriesMiddle-income countriesSimulatorsTrainingTechnology