Abstract
BackgroundThis study aims to compare the increased time needed to perform advanced focused cardiac measurements in the emergency department, including diastolic heart failure evaluation via E/E′, and cardiac output with LVOT/VTI. Patients with pertinent cardiopulmonary symptoms in the emergency department had a focused cardiac ultrasound performed by the emergency department ultrasound team. The ability to obtain basic cardiac windows, evaluate for effusion, systolic ejection fraction, and right-sided heart pressures were recorded. Advanced measurements, along with time to obtain all images and the training level of the provider, were recorded.ResultsFifty-three patients were enrolled. Basic focused cardiac windows were able to be obtained in 80% of patients. The average 4-window focused cardiac ultrasound took 4 min and 49 s to perform. Diastolic measurements were able to be obtained in 51% of patients, taking an average of 3 min and 17 s. Cardiac output measurements were able to be obtained in 53% of patients, taking an average of 3 min and 8 s.ConclusionThe ability to obtain these images improved with increasing level of training. Performing both cardiac output and diastolic measurements increased the time with bedside ultrasound by 6 min and 25 s, and were able to be obtained in slightly over half of all ED patients.
Highlights
This study aims to compare the increased time needed to perform advanced focused cardiac measurements in the emergency department, including diastolic heart failure evaluation via E/E′, and cardiac output with left ventricular outflow tract (LVOT)/velocity time integral (VTI)
A total of 53 patients were enrolled in the study. 19 of these had an ultrasound performed by a junior resident (PGY 1–2), 17 had an ultrasound performed by a senior resident (PGY 3–4), and 17 had an ultrasound performed by an ultrasound fellow
The level of training was compared with regard to time to obtain LVOT/VTI via a Test of Between-Subjects Effect, and the level of training was found to be statistically significant, F (2,22) = 4.6, p
Summary
This study aims to compare the increased time needed to perform advanced focused cardiac measurements in the emergency department, including diastolic heart failure evaluation via E/E′, and cardiac output with LVOT/VTI. The ability to obtain basic cardiac windows, evaluate for effusion, systolic ejection fraction, and right-sided heart pressures were recorded. Focused cardiac ultrasound (FOCUS) has become increasingly utilized by emergency medicine (EM) physicians to evaluate undifferentiated patients within the emergency department (ED). The ability of EM physicians to perform and interpret cardiac findings such as ejection fraction, right heart strain/function, diastolic function, fluid status, valvular dysfunction, and aortic. There are multiple methods to evaluate fluid status in the cardiopulmonary patient, including history and physical exam, FOCUS for inferior vena cava measurement, central venous pressure measurement, stroke volume variation, and passive leg raise, there remains no clear foolproof method for this evaluation. Prior research has shown that EM physicians can perform cardiac VTI measurements accurately [15]
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