Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit

Abstract

Rescue point-of-care ultrasound (r-POCUS) in critical care medicine has revolutionized the management of critically ill patients with hemodynamic instability. However, clinical studies on its use among high-risk cardiac patients still are limited. The authors aimed to assess the utility of r-POCUS for managing high-risk cardiac patients in a mixed cardiac-surgical and cardiac-medical intensive care unit (ICU) in a quaternary care hospital by reviewing the indications and findings of r-POCUS and subsequent effect on patient management. Retrospective observational study. Single institution, quaternary care hospital. The study comprised 189 consecutive r-POCUS examinations performed in a cardiac medical and surgical ICU. None. r-POCUS was performed on 141 patients. Common indications for r-POCUS included hypotension (n = 93 [49%]), assessment of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (n = 33 [17%]), arrhythmias (n = 13 [7%]), abnormal pulmonary artery catheter values (n = 11 [6%]), and ischemic electrocardiogram changes (n = 10 [5%]). Cardiac pathology was positive in 129 (68%) of the rescue examinations. Common reported pathologies included left ventricular dysfunction (n = 47 [25%]), right ventricular dysfunction (n = 52 [28%]), hypervolemia (n = 13 [7%]), hypovolemia (n = 25 [13%]), pericardial effusion/tamponade (n = 21 [11%]), and ECMO/ventricular assist device cannula malposition (n = 9 [5%]). Seventy-five percent of the rescue examinations resulted in medical and surgical interventions, including fluid resuscitation (n = 25 [13%]), diuresis (n = 14 [7%]), ionotropic support (n = 23 [12%]), surgical intervention in the operating room (n = 21 [11%]), surgical intervention at the bedside (n = 8 [4%]), ECMO initiation (n = 15 [8%]), and ECMO/ventricular assist device cannula/setting adjustment (n = 12 [6%]). In this retrospective study, r-POCUS performed by attending intensivists resulted in diverse findings and was associated with rapid changes in clinical management of patients in a high-acuity, mixed cardiac-surgical and cardiac-medical ICU.