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"apellidos" => "Argente Navarro" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192920301700" "doi" => "10.1016/j.redare.2020.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920301700?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935620302024?idApp=UINPBA00004N" "url" => "/00349356/0000006700000010/v1_202011270856/S0034935620302024/v1_202011270856/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192920301682" "issn" => "23411929" "doi" => "10.1016/j.redare.2020.05.013" "estado" => "S300" "fechaPublicacion" => "2020-12-01" "aid" => "1166" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2020;67:556-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Why is Covid-19 epidemics no so intense in Africa?" 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End of April 2020.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Villalonga-Morales" "autores" => array:1 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Villalonga-Morales" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935620301444" "doi" => "10.1016/j.redar.2020.05.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935620301444?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920301682?idApp=UINPBA00004N" "url" => "/23411929/0000006700000010/v1_202012131408/S2341192920301682/v1_202012131408/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192920301712" "issn" => "23411929" "doi" => "10.1016/j.redare.2020.08.002" "estado" => "S300" "fechaPublicacion" => "2020-12-01" "aid" => "1219" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2020;67:545-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Usefulness of pre-anesthetic consultation to reduce the degree of anxiety in patients scheduled for surgical intervention" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "545" "paginaFinal" => "550" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la consulta preanestésica para disminuir el grado de ansiedad en pacientes programados para intervención quirúrgica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1277 "Ancho" => 2124 "Tamanyo" => 71791 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Level of anxiety of patients before and after the pre-anaesthesia evaluation. The columns show the total number of patients with each anxiety level. STAI 1 *: before the evaluation; STAI 2 **: after evaluation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Porcar, D. Peral" "autores" => array:2 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Porcar" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Peral" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935620302115" "doi" => "10.1016/j.redar.2020.08.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935620302115?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920301712?idApp=UINPBA00004N" "url" => "/23411929/0000006700000010/v1_202012131408/S2341192920301712/v1_202012131408/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Report</span>" "titulo" => "Multicentric survey on the use of intraoperative echocardiography in cardiovascular surgery in Spain" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "551" "paginaFinal" => "555" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Carmona García, I. Zarragoikoetxea Jauregui, E. Mateo, R. García Fuster, R. Vicente, P. Argente Navarro" "autores" => array:6 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Carmona García" "email" => array:1 [ 0 => "paulac_g@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Zarragoikoetxea Jauregui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Mateo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "García Fuster" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "R." "apellidos" => "Vicente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "P." "apellidos" => "Argente Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, Miembro del Grupo de Trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR, Coordinadora del Grupo de Trabajo en Ecocardiografía Transesofágica Intraoperatoria de la SEDAR, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Cirugía Cardiaca, Consorcio Hospital General Universitario de Valencia, Coordinador del Grupo de Trabajo en Ecocardiografía Transesofágica Intraoperatoria de la SECCE, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Encuesta multicéntrica sobre el empleo de la ecocardiografía intraoperatoria en cirugía cardiovascular en España. Artículo breve" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1032 "Ancho" => 2500 "Tamanyo" => 86308 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Systematic written report of intraoperative findings.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Transoesophageal echocardiography (TOE) is a fundamental tool for the anatomical and functional assessment of cardiac structures and haemodynamic management during the intraoperative and postoperative period of cardiac surgery. In 2013, the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) published a series of recommendations and indications for the performance of intraoperative TOE in which they recommended using TOE in all cardiac surgeries and in thoracic aortic procedures in the absence of contraindications.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> However, the high cost of the equipment and the difficulties encountered in providing structured, supervised training and in the acquisition of formal certification of intraoperative TOE skills by anaesthesiologists, has meant that the intraoperative use of this technique in Spain is heterogeneous and unevenly distributed. In addition, the scarcity of accredited training centres in TOE skills means that any training acquired is brief and predominantly self-taught. There is little information available on the use of this imaging modality in the intraoperative period and on the training given to TOE operators in our setting.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this study we ascertain the current status of TOE in intraoperative cardiac surgery in Spain by conducting a national survey that explores the availability of TOE equipment, the indication for and use of this technique, as well as the training and certification of TOE operators.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">From May to September 2019, a nationwide survey was conducted among anaesthesiologists and cardiovascular surgeons who are members of the Cardiovascular and Thoracic Anaesthesia and Post-anaesthesia Care division of the Spanish Society of Anaesthesia and Critical Care (SEDAR, in its Spanish acronym) and the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE, in its Spanish acronym). The survey, which consisted of an 18-item questionnaire created on Google Forms, was sent via email to professional members of the aforementioned scientific societies working in the 52 hospitals that perform cardiac surgery in Spain. All responses were anonymous. The 18 questions were grouped into 3 blocks: (1) volume of surgeries, indications for TOE and availability of equipment; (2) who performs echocardiography and who participates in decision-making, and (3) attending anaesthesiologist’s or surgeon’s level of training in the acquisition and interpretation of images.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">The questionnaire was sent to 200 specialists, of which 53 surgeons and 44 anaesthesiologists responded.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Volume of surgeries, indications for TOE and availability of equipment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Half (55.8%) of respondent anaesthesiologists belong to a hospital where more than 500 surgeries/year are performed, and 25.5% to hospitals performing more than 400 surgeries/year. Of respondent surgeons, 34% work in hospitals where more than 300 surgeries/year are performed, and 24.5% in hospitals with more than 500 surgeries/year. Slightly less than half (41.9%) of respondent anaesthesiologists are involved in the intraoperative or postoperative care of more than 4 patients/week, and 41.5% of surgeons participate in more than 3 interventions/week.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Half (50.4%) of respondents have 2 complete TOE devices for cardiac surgery, used both intraoperatively and postoperatively, and 31.5% have at least 1 such device.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In total, 47.2% answered that TOE is used routinely in all interventions, and 35.8% said it was used in almost all surgeries where it was recommended in the guidelines (valve repair surgery, surgery to correct ventricular dysfunction, aortic surgery). Very few (13.2%) surgeons polled answered that they only use intraoperative TOE in valve repair surgery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Who performs the echocardiography and who participates in decision making; written report</span><p id="par0040" class="elsevierStylePara elsevierViewall">According to 70.9% of respondents, the attending anaesthesiologist performs the TOE (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). When asked who is routinely responsible for making decisions based on intraoperative TOE findings that have an impact on the clinical management of the patient, 59.1% answered that the decision is made by consensus between the attending anaesthesiologist and the cardiologist; 29.5% responded that decisions are routinely made by the anaesthesiologist alone, and 11.4% systematically request a consultation with the Cardiology Service. However, in the postoperative period, 69.8% responded that the intensivist/post-anaesthesia specialist is responsible for decisions based on echocardiographic findings, and 23.3% responded that this decision lies with the Cardiology Service.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">When asked whether a written report of intraoperative findings is systematically made, 27.3% of respondents answered that they report the echocardiographic evaluation, 43.2% do not, and 29.5% do so occasionally. In postoperative evaluations, 45.2% of respondents state that they occasionally report their findings (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Level of training of the attending anaesthesiologist or surgeon</span><p id="par0050" class="elsevierStylePara elsevierViewall">Most (70.5%) of the anaesthesiologists polled had received specific training in TOE; 50% had received training in TOE during a rotation, and 54.5% had received training in transthoracic echocardiography. In 53.3% of cases, the rotation lasted at least 1 month, in 13.3% it lasted more than 1 month, and in 16.7% it lasted more than 2 months. A small percentage (9.1%) of anaesthesiologists had undergone a fellowship or specific training program in cardiovascular anaesthesia after completing their specialist training in Anaesthesiology and Critical Care (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In total, 65.9% reported that one or several of their service members have official certification, and only 34.1% stated that none of their members have official certification in TOE.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding continuing medical training, 31.8% of respondents receive 1 such training course per year in TOE, and 97.7% believe it necessary to implement specific training programs in TOE for both anaesthesiologists and cardiovascular surgeons, as well as for trainees in both specialties during their resident training stage.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">This, to the best of our knowledge, is the first study on the use of perioperative TOE by anaesthesiologists and cardiovascular surgeons in Spain, and it has shown some important results. First, it provides a general understanding of the depth of penetration of the technique and the availability of TOE equipment. The standardization of this monitoring technique in modern cardiac surgery and its routine use in most procedures is confirmed by the fact that 83% of respondents always or almost always use it. Second, the survey clearly shows that the anaesthesiologist is usually in charge of performing echocardiography (70% affirm that it is performed by the anaesthesiologist), although in most cases the cardiologists is involved in TOE-related decision-making. Third, regulated, structured training in TOE for anaesthesiologists is still scarce, non-standardized, and usually lasts less than 2 months. However, 61.3% of respondents receive continuing medical training every year or every 2 years, and 65.9% confirm the presence of a certified TOE operator in their service.</p><p id="par0070" class="elsevierStylePara elsevierViewall">As in other developed countries, TOE has rapidly been incorporated into routine practice because of its advantages in both haemodynamic monitoring and in the anatomical and functional assessment of procedures. The technique is promoted and recommending by clinical guidelines, and its use in Spain is similar to other countries. However, it is interesting to note that 13.2% of surgeons polled only use echocardiography in valve repair surgery. This questionnaire, like other similar surveys, has also shown that TOE is routinely available in hospitals<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–4</a>).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Most respondent anaesthesiologists and surgeons work in high-volume hospitals, and the number of cardiac patients they treat per week shows that they are actively involved in the Cardiac Surgery Service. No standardized training curriculum in perioperative echocardiography for residents or consultants has yet been introduced in Spain. In accordance with the recommendations of the ASE and the EACVI, 20 h of continuing medical education and the performance and supervised interpretation of at least 50 transthoracic echocardiography examinations and 150 supervised TOE examinations are needed to acquire a basic level of expertise in this discipline.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The European Association of Cardiothoracic Anaesthesiology (EACTA) recently published a consensus document defining the competencies to be acquired during training programs or fellowships in cardiovascular anaesthesia,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> in which they recommend obtaining official (EACVI/EACTA) accreditation in TOE in order to practice as an independent cardiac anaesthesiologist in Europe.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The results of our survey are consistent with this recommendation, since 65.9% of respondents confirm that at least 1 member of the Anaesthesia and Cardiovascular Service has obtained advanced certification in TOE.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In Spain there are several well-established courses providing annual theoretical training in perioperative TOE, and an increasing number of virtual and online training course are also available. However, there is still no standardised curriculum and no formally accredited centres offering structured training, a situation reflected by the fact that only 9.1% of respondents have received formal training in specific programs, usually held abroad. This situation is similar to that reported in countries such as China, where TOE skills are not included in basic medical training.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">On the subject of reporting, only 23.8% of respondents regularly prepare standardized reports on TOE findings. All scientific societies recommend reporting the main pre- and postoperative findings and conclusions using standardized templates. This allows the information to be transmitted to the rest of the medical team, facilitates patient follow-up, and allows studies performed by different professionals in different hospitals to be compared. These findings contrast greatly with other surveys conducted in the US or Canada, where anaesthesiologists perform the technique in 85% of hospitals, and formally report the findings in up to 78% of cases<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a>.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The limitations of this study are those inherent to its methodology, since the questionnaire was sent to anaesthesiologists and surgeons who are members of SEDAR and SECCE and belong to the cardiovascular and thoracic anaesthesia division of SEDAR. This means that other professionals who are not members of these societies will not have received questionnaire, and consequently their experience has not been taken into account. The response rate, 47.2%, is a further limitation insofar as it ignores the opinion and experiences of over half of the subjects polled. The questionnaire did not include questions on the respondent’s experience in the field of cardiovascular surgery or information about their geographic location.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion, intraoperative TOE is now an integral part of cardiovascular procedures, and in most hospitals it is performed by anaesthesiologists who are heavily involved in this type of surgery. Despite the absence of structured TOE training in the anaesthesiology curriculum, anaesthesiologists acquire skills through specific short-term rotations and a high percentage of them have obtained the official certification recommended by European scientific societies (EACTA/EACVI). However, the development of an official training pathway at the national level and endorsed by our own scientific societies would improve the quality of our professional development and patient care.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1432406" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1307560" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1432407" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1307561" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Volume of surgeries, indications for TOE and availability of equipment" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Who performs the echocardiography and who participates in decision making; written report" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Level of training of the attending anaesthesiologist or surgeon" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-18" "fechaAceptado" => "2020-07-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1307560" "palabras" => array:5 [ 0 => "Transesophageal echocardiography" 1 => "Monitoring" 2 => "Cardiac surgery" 3 => "Training" 4 => "Accreditation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1307561" "palabras" => array:5 [ 0 => "Ecocardiografía transesofágica" 1 => "Monitorización" 2 => "Cirugía cardiaca" 3 => "Formación" 4 => "Acreditación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La ecocardiografía transesofágica (ETE) es una herramienta fundamental en el intraoperatorio y postoperatorio de cirugía cardiaca con una gran difusión en los últimos años. El objetivo de este trabajo es conocer la situación actual de la ETE en el ámbito de la anestesiología en cirugía cardiaca en España a través de una encuesta nacional que explora la disponibilidad de equipos, indicación y utilización de dicha técnica, así como la formación y acreditación de los profesionales responsables.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los hallazgos muestran que en España la ETE intraoperatoria es parte integral de los procedimientos cardiovasculares hoy en día y en la mayor parte de los centros es realizada por anestesiólogos altamente involucrados en este tipo de cirugías. A pesar de la ausencia de formación estructurada en el currículum formativo de nuestra especialidad, los anestesiólogos adquieren las competencias mediante rotaciones específicas de corta duración y un alto porcentaje de ellos ha obtenido la acreditación oficial.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Carmona García P, Zarragoikoetxea Jauregui I, Mateo E, García Fuster R, Vicente R, Argente Navarro P. Encuesta multicéntrica sobre el empleo de la ecocardiografía intraoperatoria en cirugía cardiovascular en España. Artículo breve. Rev Esp Anestesiol Reanim. 2020;67:551–555.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 931 "Ancho" => 2148 "Tamanyo" => 67415 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Use and indications of intraoperative TOE.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 956 "Ancho" => 2379 "Tamanyo" => 99922 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Who routinely performs intraoperative TOE.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1032 "Ancho" => 2500 "Tamanyo" => 86308 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Systematic written report of intraoperative findings.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 946 "Ancho" => 2477 "Tamanyo" => 90304 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Duration of specific training in TOE.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the american society of echocardiography and the society of cardiovascular anesthesiologists" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.T. Hahn" 1 => "T. Abraham" 2 => "M.S. Adams" 3 => "C.J. Bruce" 4 => "K.E. Glas" 5 => "R.M. Lang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.echo.2013.07.009" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2013" "volumen" => "26" "paginaInicial" => "921" "paginaFinal" => "964" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23998692" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for transoesophageal echocardiography: EACVI update 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.A. Flachskampf" 1 => "P.F. Wouters" 2 => "T. Edvardsen" 3 => "A. Evangelista" 4 => "G. Habib" 5 => "P. Hoffman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J Cardiovas Imaging" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "353" "paginaFinal" => "365" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survey of the members of the cardiovascular section of the Canadian anesthesiologists’ society on the use of perioperative transesophageal echocardiography—a brief report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Stephane Lambert" 1 => "C. David Mazer" 2 => "P.C. Duke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF03020530" "Revista" => array:6 [ "tituloSerie" => "Can J Anesth" "fecha" => "2002" "volumen" => "49" "paginaInicial" => "294" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11861349" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multinational institutional survey on patterns of intraoperative transesophageal echocardiography use in adult cardiac surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.A. Dobbs" 1 => "E. Bennett-Guerrero" 2 => "W. White" 3 => "S.K. Shernan" 4 => "A. Nicoara" 5 => "J. Mauricio Del Rio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2013.09.014" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "54" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24440009" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American College of Cardiology/American Heart Association Clinical Competence Statement on Echocardiography: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine T" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Quiñones" 1 => "P.S. Douglas" 2 => "E. Foster" 3 => "J. Gorcsan" 4 => "J.F. Lewis" 5 => "A.S. Pearlman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.0000061708.42540.47" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2003" "volumen" => "107" "paginaInicial" => "1068" "paginaFinal" => "1089" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12600924" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.A. Popescu" 1 => "M.J. Andrade" 2 => "L.P. Badano" 3 => "K.F. Fox" 4 => "F.A. Flachskampf" 5 => "P. Lancellotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ejechocard/jep151" "Revista" => array:6 [ "tituloSerie" => "Eur J Echocardiogr" "fecha" => "2009" "volumen" => "10" "paginaInicial" => "893" "paginaFinal" => "905" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19889658" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perspectives on the fellowship training in cardiac, thoracic, and vascular anesthesia and critical care in Europe from program directors and educational leads around Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.R. El Tahan" 1 => "L.E. Mendoza Vasquez" 2 => "R.P. Alston" 3 => "G. Erdoes" 4 => "J.U. Schreiber" 5 => "J. Fassl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2019" "volumen" => "34" "paginaInicial" => "512" "paginaFinal" => "520" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Association of Cardiothoracic Anesthesiology (EACTA) cardiothoracic and vascular anesthesia fellowship curriculum: first edition" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Erdoes" 1 => "A. Vuylsteke" 2 => "J.U. Schreiber" 3 => "R.P. Alston" 4 => "S.J. Howell" 5 => "P.F. Wouters" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2019.12.014" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2020" "volumen" => "34" "paginaInicial" => "1132" "paginaFinal" => "1141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31948892" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraoperative transesophageal echocardiography during cardiovascular surgery in China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Wang" 1 => "J. Wei" 2 => "S. Yuan" 3 => "Y. He" 4 => "J. Han" 5 => "J. Lu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2018.10.027" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2019" "volumen" => "33" "paginaInicial" => "1343" "paginaFinal" => "1350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30467029" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Report on cardiac anesthesia progress and challenges in China" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Lu" 1 => "W. Cheng" 2 => "J. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2017.12.050" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2018" "volumen" => "32" "paginaInicial" => "2365" "paginaFinal" => "2371" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29397293" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006700000010/v1_202012131408/S2341192920301700/v1_202012131408/en/main.assets" "Apartado" => array:4 [ "identificador" => "36321" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006700000010/v1_202012131408/S2341192920301700/v1_202012131408/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920301700?idApp=UINPBA00004N" ]
