A review of echocardiography in anaesthetic and peri‐operative practice. Part 2: training and accreditation

Abstract

Summary Echocardiography has been widely adopted as a diagnostic and monitoring tool in cardiac anaesthesia and critical care. There is considerable interest in how echocardiography could be used to benefit patients in other areas of anaesthesia and peri‐operative practice. The first part of review examines the impact and utility of echocardiography, while this second part is concerned with the matter of training and accreditation. There are a number of existing clinical protocols for the use of transthoracic echocardiography with a focused approach. Some of these, such as Focused Intensive Care Echocardiography in the UK, have been developed into structured accreditation processes with embedded supervision. Learning opportunities are now emerging for anaesthetists who wish to acquire echocardiography skills – these encompass clinical, simulation and online resources. Whilst the roll‐out of echocardiography for more widespread use in peri‐operative management is a long‐term project, it is now an appropriate time to consider how this may be achieved.

Simulation‐based teaching versus point‐of‐care teaching for identification of basic transoesophageal echocardiography views: a prospective randomised study

“…There is also interest within the anaesthesia community about how the acquisition of echocardiography skills may impact on the management of patients, and how these skills may be obtained as a result of a training programme [17,18]. Currently, effective TOE training is often only available to those undertaking a cardiothoracic anaesthesia or an Table 2 Satisfaction of study subjects with their respective teaching method.…”

Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland

“…The percentage error of pulse contour analysis, oesophageal Doppler, partial carbon dioxide rebreathing, and transthoracic bio‐impedance has been shown to be greater than 30%, a widely accepted cut‐off 25. The use of cardiac output monitoring for assessment of fluid responsiveness has been shown to be more accurate, but inter‐patient variability and dynamic changes in stroke volume may be significant 26.The cardiac output monitors currently available all have advantages and disadvantages associated with their use, and the AAGBI Working Party cannot recommend one type over another.In summary: the pulmonary artery catheter is the most accurate, but less invasive monitoring has superseded its routine use outside of cardiac surgery 27;there is conflicting evidence about whether the use of cardiac output monitoring improves patient outcomes, and this is an area of ongoing research;echocardiography can be used to estimate cardiac output and allows cardiac function and filling status to be directly observed ‐ however, training and experience in its use is required 28, 29;there remains doubt about the accuracy of all cardiac output monitoring devices currently available, and data are mostly confined to patients whose lungs are mechanically ventilated;the use of cardiac output monitors to assess fluid responsiveness has some evidence base. …”

“…In summary: the pulmonary artery catheter is the most accurate, but less invasive monitoring has superseded its routine use outside of cardiac surgery 27;there is conflicting evidence about whether the use of cardiac output monitoring improves patient outcomes, and this is an area of ongoing research;echocardiography can be used to estimate cardiac output and allows cardiac function and filling status to be directly observed ‐ however, training and experience in its use is required 28, 29;there remains doubt about the accuracy of all cardiac output monitoring devices currently available, and data are mostly confined to patients whose lungs are mechanically ventilated;the use of cardiac output monitors to assess fluid responsiveness has some evidence base. …”

“…echocardiography can be used to estimate cardiac output and allows cardiac function and filling status to be directly observed ‐ however, training and experience in its use is required 28, 29;…”

Intraoperative Transesophageal Echocardiography: Review and Evolution

“…Yet, it is possible to a trainee who spends a year in cardiac anesthesia training programme develop required skills to perform a full TEE examination if the equipment can be made accessible. Basic perioperative TE training is mostly dedicated on intraoperative monitoring, whereas advanced training aims on specific diagnoses [63,64].…”