Incorporating advanced echocardiography into clinical practice #LIVES2017

It was delightful listening to Paul Mayo deliver this excellent talk based on his clinical experience.

Critical care echocardiography is a different beast to the traditional “echo lab” approach favoured by cardiology. Our environment does not lend itself well to hour long studies per patient recording every measurement.

His unit adopts a flexible approach, deploying aspects of advanced echo as needed to answer specific clinical questions. Occasionally a full study will be performed. For quality control reasons, all their TOEs (TEEs) are full studies.

NYC is staffed by 10 attending and 6 “night owls”, all of whom are competent in general critical care ultrasound. 3 of the team are competent in advanced echo.

As an example of how they apply advanced skills, All shocked patients will get VTI to estimate stroke volume. Other measurements are used selectively such as:

  • E/e’ to estimate filling pressures
  • Bubble studies for hypoxemia
  • Quantitative studies of valve function
  • Precise measurements of RV function (PASP, PADP, PAMP, RV S’, PAT, TAPSE)
  • Regional wall motion abnormality assessments
  • serial echoes for dobutamine or nitric oxide trials

Images are saved, and relevant findings documented in notes (except TOEs which all get a ful, report). Interesting cases are discussed at a weekly meeting.

For those training in advanced CCE, Mayo recommends ALL views and ALL measurements are performed in a specific sequence, and images rejected if they are suboptimal. Not only does it upskill the user, it brings credibility to the field and reassures our cardiology and imaging colleagues.

These were certainly useful points that all of us in the critical care and imaging community should take note of.