Point-of-care ultrasound (POCUS) use by non-sonographers has grown substantially in recent years. The American Society of Echocardiographer (ASE) has met this trend by growing more involved in training programs for POCUS users, especially in the fields of critical care and anesthesia. This includes developing ASE guidelines for POCUS exams and training.
Jackie Sohn, DO, an intensivist and anesthesiology fellow at Baylor College of Medicine/Texas Heart Institute, spoke at the 2023 ASE meeting on POCUS and how it is now incorporated into fellowship training programs. She also explained how these handheld and smaller cart-based systems are being utilized in hospitals to perform cardiac ultrasound outside of the echo lab.
"In the ICU, it is used for the evaluation of life-threatening situations to rule things out, such as tamponade and shock. A lot of times, it is going to be a hemodynamics evaluation for things like volume status. We definitely look at the heart, but also the lungs, liver and kidneys, so it is usually for multi-organ evaluations," Sohn explained.
Often these quick POCUS exams provide enough information for the clinician to care for the patient. But when it appears there are other issues involved, or more detailed information is needed, Sohn said the POCUS can help determine if a more through, full echocardiogram is required by an expert sonographer.
"POCUS is more for that bedside, acute management of the patient, but if a more though exam is needed, we definitely consult with a sonographer or echocardiographer to get involved," Sohn said.
Formalized echo training for non-echocardiographers
Intensivists and anesthesiologists need to complete a combination of didactic and workshop classes to become National Board of Echocardiography (NBE) certified to perform echocardiograms. This includes passing a critical care echocardiography examination and performing 150 clinically necessary patient echo exams.
Sohn said the anesthesiology oral board exams now require knowledge of POCUS. This education begins during training and continues through fellowship. It includes two to three months of intensive training, she said.
Anesthesiologists also use POCUS for needle guidance for regional nerve blocks and for pre-operative patient evaluations. The pre-op exams usually include a basic echo exam and a look into the stomach to to see its contents and assess the risk of vomiting before a patient goes under.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com