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      Focus-Assessed Transthoracic Echocardiography: Implications in Perioperative and Intensive Care

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          Abstract

          Transthoracic echocardiography is a potent and appealing diagnostic tool by virtue of rapidity, noninvasiveness, and repeatability. Focus-assessed transthoracic echocardiography (FATE) forms quick guidance to interpret the echocardiographic information and relates it to the clinical context. It can be applied in the perioperative period, intensive care units (ICUs), and emergency situations, in trauma and as resuscitation aids. FATE intents to assess cardiac function including contractility, chamber size and hypertrophy, valvular dysfunction, cardiac tamponade, and pericardial and pleural effusions. Thence, FATE has become a quintessential scanning tool perioperatively and in ICUs.

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          Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial.

          Raoul Breitkreutz, Susanna Price, Holger Steiger … (2010)
          Focused ultrasound is increasingly used in the emergency setting, with an ALS-compliant focused echocardiography algorithm proposed as an adjunct in peri-resuscitation care (FEEL). The purpose of this study was to evaluate the feasibility of FEEL in pre-hospital resuscitation, the incidence of potentially treatable conditions detected, and the influence on patient management. A prospective observational study in a pre-hospital emergency setting in patients actively undergoing cardio-pulmonary resuscitation or in a shock state. The FEEL protocol was applied by trained emergency doctors, following which a standardised report sheet was completed, including echo findings and any echo-directed change in management. These reports were then analysed independently. A total of 230 patients were included, with 204 undergoing a FEEL examination during ongoing cardiac arrest (100) and in a shock state (104). Images of diagnostic quality were obtained in 96%. In 35% of those with an ECG diagnosis of asystole, and 58% of those with PEA, coordinated cardiac motion was detected, and associated with increased survival. Echocardiographic findings altered management in 78% of cases. Application of ALS-compliant echocardiography in pre-hospital care is feasible, and alters diagnosis and management in a significant number of patients. Further research into its effect on patient outcomes is warranted. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
          Article 0 comments Cited 116 times – based on 0 reviews     Review now
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            Transthoracic echocardiography for cardiopulmonary monitoring in intensive care.

            M. B. Jensen, E Sloth, K. Larsen … (2004)
            To evaluate the feasibility of an abbreviated focus assessed transthoracic echocardiographic protocol, consisting of four standardized acoustic views for cardiopulmonary screening and monitoring. The protocol was applied in 210 patients in a 20-bed multidisciplinary intensive care unit in a university hospital. When inconclusive, an additional transoesophageal echocardiographic examination was performed. Diagnosis, indication, acoustic window, position and value were recorded. Significant pathology, load, dimensions and contractility were assessed. Two-hundred-and-thirty-three transthoracic and four transoesophageal echoes were performed. The protocol provided usable images of the heart in 97% of the patients, 58% subcostal, 80% apical and 69% parasternal. Images through one window were obtainable in 23%, through two windows in 41% and through three windows in 34%. In 227 patients (97.4%) the focus assessed echo protocol contributed positively. In 24.5% of cases the information was decisive, in 37.3% supplemental and in 35.6% supportive. By means of an abbreviated, focus assessed transthoracic echo protocol it is feasible to visualize the haemodynamic determinants for assessment and optimization. One or more useful images are obtainable in 97% of critically ill patients.
            Article 0 comments Cited 107 times – based on 0 reviews     Review now
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              Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm.

              T F Seeger, Raoul Breitkreutz, Felix Walcher (2007)
              Emergency ultrasound is suggested to be an important tool in critical care medicine. Time-dependent scenarios occur during preresuscitation care, during cardiopulmonary resuscitation, and in postresuscitation care. Suspected myocardial insufficiency due to acute global, left, or right heart failure, pericardial tamponade, and hypovolemia should be identified. These diagnoses cannot be made with standard physical examination or the electrocardiogram. Furthermore, the differential diagnosis of pulseless electrical activity is best elucidated with echocardiography. Therefore, we developed an algorithm of focused echocardiographic evaluation in resuscitation management, a structured process of an advanced life support-conformed transthoracic echocardiography protocol to be applied to point-of-care diagnosis. The new 2005 American Heart Association/European Resuscitation Council/International Liaison Committee on Resuscitation guidelines recommended high-quality cardiopulmonary resuscitation with minimal interruptions to reduce the no-flow intervals. However, they also recommended identification and treatment of reversible causes or complicating factors. Therefore, clinicians must be trained to use echocardiography within the brief interruptions of advanced life support, taking into account practical and theoretical considerations. Focused echocardiographic evaluation in resuscitation management was evaluated by emergency physicians with respect to incorporation into the cardiopulmonary resuscitation process, performance, and physicians' ability to recognize characteristic pathology. The aim of the focused echocardiographic evaluation in resuscitation management examination is to improve the outcomes of cardiopulmonary resuscitation.
              Article 0 comments Cited 75 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Card Anaesth
                Journal ID (iso-abbrev): Ann Card Anaesth
                Journal ID (publisher-id): ACA
                Title: Annals of Cardiac Anaesthesia
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0971-9784
                ISSN (Electronic): 0974-5181
                Publication date (Print): Jul-Sep 2019
                Volume: 22
                Issue: 3
                Pages: 302-308
                Affiliations
                [1] Department of Anaesthesia, Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Amarja Sachin Nagre, C-3, Row House, Muthiyan Residency, Deep Nagar, Aurangabad - 431 001, Maharashtra, India. E-mail: dramarja. 1@ 123456gmail.com
                Article
                Publisher ID: ACA-22-302
                DOI: 10.4103/aca.ACA_88_18
                PMC ID: 6639886
                PubMed ID: 31274494
                SO-VID: a8523cda-97f9-46a8-9d94-74287933dc73
                Copyright © Copyright: © 2019 Annals of Cardiac Anaesthesia
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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                Categories
                Subject: Review Article

                Keywords: critical care,echocardiography,focus-assessed transthoracic echocardiography,focused transthoracic echocardiography,intensive care,ultrasonography
                Data availability:
                Keywords: critical care, echocardiography, focus-assessed transthoracic echocardiography, focused transthoracic echocardiography, intensive care, ultrasonography

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