Focused Cardiac Ultrasonography: Current Applications and Future Directions

Abstract

Focused cardiac ultrasonography is performed by clinicians at the bedside and is used in time-sensitive scenarios to evaluate a patient's cardiovascular status when comprehensive echocardiography is not immediately available. This simplified cardiac ultrasonography is often performed by noncardiologists using small, portable devices to augment the physical examination, triage patients, and direct management in both critical care and outpatient settings. However, as the use of focused cardiac ultrasonography continues to expand, careful consideration is required regarding training, scope of practice, impact on patient outcomes, and medicolegal implications. In this review, we examine some of the challenges with rapid uptake of this technique and explore the benefits and potential risk of focused cardiac ultrasonography. We propose possible mechanisms for cross-specialty collaboration, quality improvement, and oversight.

Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist

“…65 In the aforementioned study, major findings from anesthesiologist-performed FOCUS examinations (ie, significant valvular lesions) were confirmed subsequently by cardiology evaluation in 92% of patients. Massive pulmonary embolism and cardiac tamponade are potentially devasting perioperative complications in which FOCUS provides rapid diagnostic confirmation to guide immediate lifesaving 66 FOCUS also is emerging as a valuable tool in the diagnosis and management of cardiac arrest. The Focused Echocardiographic Examination in Life protocol describes FOCUS usage during performance of advanced cardiac life support (ACLS) protocols.…”

Basic echocardiography competence program in intensive care units: A multinational survey of intensive care units accredited by the College of Intensive Care Medicine

“…Internationally, the lack of structured workplacebased ultrasound teaching has been recognised as one of the barriers for competence. [4][5][6] There are no data regarding BCCE competence programmes available in CICM-accredited intensive care units (ICUs). Since there are CICM-accredited training units in Australia, New Zealand, Hong Kong, Singapore, Ireland and India, we conducted a multinational survey to evaluate the status of BCCE training in these ICUs.…”

Focused Cardiac Ultrasound to Guide the Diagnosis of Heart Failure in Pregnant Women in India

“…The concept of FoCUS 5 is widely recommended for settings where standard echocardiography is not readily available or to augment clinical assessments for time-sensitive clinical decisions. [6][7][8][9] It is based on the concept of ''task shifting,'' whereby trained health care providers (with no previous expertise) perform echocardiography with portable devices using a simple imaging protocol. 6,7,10 This method has been proved to improve efficiency in initial clinical diagnosis, which can be later confirmed on standard transthoracic echocardiography.…”

“…[6][7][8][9] It is based on the concept of ''task shifting,'' whereby trained health care providers (with no previous expertise) perform echocardiography with portable devices using a simple imaging protocol. 6,7,10 This method has been proved to improve efficiency in initial clinical diagnosis, which can be later confirmed on standard transthoracic echocardiography. 6,7,10 Although at present, FoCUS is used mainly in high-income settings in emergency medicine, anesthesia, and critical care, we found some studies from LMICs showing that this approach was effective in screening and early diagnosis of rheumatic heart disease in schoolchildren, [11][12][13][14][15][16] even when images were acquired by nonexperts and interpreted remotely by experts.…”