Training in POCUS echocardiography for intensivists

Abstract

Point of care ultrasound (POCUS) Echocardiography is an essential non-invasive, bed-side imaging tool for managing patients in the intensive care unit (ICU). In ICU literature, POCUS echocardiography refers to focused echocardiography, basic echocardiography, and level 1 echocardiography. This approach mainly uses 2D ultrasound, and the primary goal of POCUS Echocardiography is to evaluate the cause of shock by answering a few critical questions about the cardiac structure and function. Currently, many international and national guidelines for POCUS echo in ICU exist. The Australia and New Zealand College of Intensive Care Medicine has made POCUS echocardiography learning a necessary component of training since 2014. However, it continues to be a significant challenge to learn POCUS echocardiography in ICU. This challenge is not only for current trainees but also for consultants who trained in the era when POCUS machines were not readily available at the bedside. Echocardiography image acquisition, unlike other skills, requires consistent, supervised, and deliberate practice to master. Not just image acquisition, but also the interpretation of findings in the clinical context is important. An ICU trainee or consultant who wants to learn echocardiography has several challenges to overcome during their journey of learning POCUS echocardiography. First and foremost is organizing the time in the busy clinical work to learn echocardiography. The second one is finding a supervisor as the availability of supervisors is limited in many ICUs. The third challenge is to get the basic views as patients in ICU have difficult acoustic windows due to mechanical ventilation, positioning restrictions, chest drains, and ECG leads. The fourth challenge is to put the findings on echocardiography in the clinical context to come up with a management plan. On the other hand, the main problem for supervisors of POC echocardiography is to keep the trainee's enthusiasm throughout their learning as the learning can be quite frustrating, especially at the beginning of the learning curve. This main aim of the current presentation is to summarise various educational techniques that a trainee and supervisor can use to make the echocardiography learning easy. The talk will discuss the current guidelines, issues with the current teaching methodologies, and about the novel ways of teaching POCUS Echocardiography (for example, simulators).