Focused cardiac ultrasound examination in the emergency and critical care horse: Training for non‐specialist veterinarians and evaluation of proficiency

Abstract

Background: Focused cardiac ultrasound examination (FoCUS) is rapidly emerging for point-of-care cardiac assessment using hand-carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available. Hypothesis:To gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device.Animals: Three healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS).Methods: Prospective educational study. An eFoCUS protocol and 1-day training course were developed. Pre-and post-course written tests were administered to participants to evaluate proficiency in knowledge of echocardiography and echocardiographic pathology. A post-course practical examination involved performing eFoCUS and storage of representative images. Images were evaluated using an image quality score and compared between participants with some practical experience and participants with no practical experience.Results: Participants' knowledge of echocardiography increased significantly. Recognition of echocardiographic pathology pre-course ranged from 40% to 90% (mean score, 65.7%) and post-course from 85% to 100% (mean score, 92%). Eighteen of 21 participants were proficient in performing eFoCUS with a median image quality score of 79% (range, 42%-95%). Image quality did not differ between participants with some practical experience compared to participants with no experience. Conclusions and ClinicalImportance: Veterinarians and veterinary students independent of previous experience can become proficient in performing eFoCUS after completion of a 1-day training course. Abbreviations: Ao, aorta; ASE, American Society of Echocardiography; eFoCUS, equine focused cardiac ultrasound; HCU, hand-carried ultrasound; LA, left atrium or left atrial; LV, left ventricle or left ventricular; LVOT, left ventricular outflow tract; PA, pulmonary artery; POCUS, point-of-care ultrasound; R-4C, right-parasternal long-axis 4-chamber view; R-AoSAX, right-parasternal shortaxis view at the level of the aortic valve; R-LVOT, right-parasternal left ventricular outflow tract view; R-LVSAX, right-parasternal short-axis view of the left ventricle at the level of the chordae tendineae; R-RVOT, right-parasternal right ventricular outflow tract view; RV, right ventricle or right ventricular; RVOT, right ventricular outflow tract.

Utility of focused cardiac ultrasonography training in veterinary students to differentiate stages of subclinical myxomatous mitral valve disease in dogs

“…Our results agree with similar studies in large animal species as well as in studies performed in human medical school students. In 1 study, 24 F I G U R E 5 Student self-reported confidence in performing focused cardiac ultrasound at the start of and after a 2-week clinical cardiology rotation involving didactic instruction and hands-on practice. There was a significant difference in students reporting high/ very high, moderate, or low/very low (χ 2 = 70.5; P < .0001).…”

Feasibility of a point‐of‐care ultrasound protocol for cardiorespiratory evaluation of horses in different clinical settings

“…In a recent study, participants who were non-specialist practitioners learned to perform and interpret a focused echocardiographic protocol for horses independent of previous experience in a 1-day course using Peyton's 4-step approach. 20 The described protocol was feasible in horses participating in equestrian events. Similarly, the use of focused cardiac ultrasound by sports medicine physicians has proved successful for acquiring images that recognize common causes of sudden athletic death such as hypertrophic cardiomyopathy and aortic root dilatation in human athletes.…”

“…At the time of the study, sonographer 1 had not achieved this number and it is reasonable to believe that skills were developing but above average for the general population of equine practitioners who might use CRASH. In a recent study, participants who were non‐specialist practitioners learned to perform and interpret a focused echocardiographic protocol for horses independent of previous experience in a 1‐day course using Peyton's 4‐step approach 20 …”

“…In a recent study, participants who were non‐specialist practitioners learned to perform and interpret a focused echocardiographic protocol for horses independent of previous experience in a 1‐day course using Peyton's 4‐step approach. 20 …”

“…Point‐of‐care ultrasound protocols for the evaluation of adult horses with colic (FLASH) and high‐risk pregnancies have been evaluated 18,19 . Preliminary concepts of POCUS protocols for horses designed to define standards of training, indications and diagnostic accuracy of focused echocardiography, and POCUS for cardiorespiratory assessment recently were introduced 20 . The goal of these protocols is to make medical care accessible while maintaining or improving standards of care in general and specialty practice.…”