Focus Assessed Transthoracic Echocardiography Research Articles

Pro: Does Every Anesthesiologist Need to Learn Point-of-Care Ultrasound?

THE APPLICATIONS OF ULTRASOUND for the anesthesiologist are diverse and expanding rapidly. Although national society guidelines governing the appropriate use of ultrasound in anesthesiology have been available only for transesophageal echocardiography (TEE) and vascular access imaging, clinical guidance has more recently been published describing the use of focused cardiac ultrasound in multiple clinical contexts. 1 Troianos CA Hartman GS Glas KE et al. Guidelines for performing ultrasound guided vascular cannulation: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2011; 24: 1291-1318 Abstract Full Text Full Text PDF PubMed Scopus (257) Google Scholar , 2 American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal EchocardiographyPractice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology. 2010; 112: 1084-1096 Crossref PubMed Scopus (391) Google Scholar , 3 Spencer KT Kimura BJ Korcarz CE et al. Focused cardiac ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013; 26: 567-581 Abstract Full Text Full Text PDF PubMed Scopus (398) Google Scholar , 4 Via G Hussain A Wells M et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014; 27 (683.e1-683.e33) Abstract Full Text Full Text PDF PubMed Scopus (368) Google Scholar Additionally, numerous point-of-care ultrasound (POCUS) protocols now exist to guide the examination of nearly every organ system and area, including cardiac, pulmonary and/or pleural, abdominal, genitourinary, ocular, and airway. 4 Via G Hussain A Wells M et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014; 27 (683.e1-683.e33) Abstract Full Text Full Text PDF PubMed Scopus (368) Google Scholar , 5 Haskins SC Bronshteyn Y Perlas A et al. American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part I: Clinical indications. Reg Anesth Pain Med. 2021; 46: 1031-1047 Crossref PubMed Scopus (15) Google Scholar , 6 Haskins SC Bronshteyn Y Perlas A et al. American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part II: Recommendations. Reg Anesth Pain Med. 2021; 46: 1048-1060 Crossref PubMed Scopus (14) Google Scholar , 7 Holm JH Frederiksen CA Johl-Olsen P et al. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesth Analg. 2012; 115: 1029-1032 Crossref PubMed Scopus (71) Google Scholar , 8 Lichtenstein DA Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol. Chest. 2008; 134: 117-125 Abstract Full Text Full Text PDF PubMed Scopus (1146) Google Scholar , 9 Volpicelli G Elbarbary M Blaivas M et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012; 38: 577-591 Crossref PubMed Scopus (1758) Google Scholar , 10 Scalea TM Rodriguez A Chiu WC et al. Focused Assessment with Sonography for Trauma (FAST): Results from an international consensus conference. J Trauma. 1999; 46: 466-472 Crossref PubMed Google Scholar , 11 Perlas A Van de Putte P Van Houwe P et al. I-AIM framework for point-of-care gastric ultrasound. Br J Anaesth. 2016; 116: 7-11 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar

Focused Cardiac Ultrasound to Guide the Diagnosis of Heart Failure in Pregnant Women in India

Cardiac complications are a leading cause of maternal death. Cardiac imaging with echocardiography is important for prompt diagnosis, but it is not available in many low-resource settings. The aim of this study was to determine whether focused cardiac ultrasound performed by trained obstetricians and interpreted remotely by experts can identify cardiac abnormalities in pregnant women in low-resource settings. A cross-sectional study was conducted among 301 pregnant and postpartum women recruited from 10 hospitals across three states in India. Twenty-two obstetricians were trained in image acquisition using a portable cardiac ultrasound device following a simplified protocol adapted from focus-assessed transthoracic echocardiography protocol. It included parasternal long-axis, parasternal short-axis, and apical four-chamber views on two-dimensional and color Doppler. Independent image interpretation was performed remotely by two experts, in the United Kingdom and India, using a standard semiquantitative assessment protocol. Interrater agreement between the experts was examined using Cohen's κ. Diagnostic accuracy of the method was examined in a subsample for whom both focused and conventional scans were available. Cardiac abnormalities identified using the focused method included valvular abnormalities (27%), rheumatic heart disease (6.6%), derangements in left ventricular size (4.7%) and function (22%), atrial dilatation (19.5%), and pericardial effusion (30%). There was substantial agreement on the cardiac parameters between the two experts, ranging from 93.6% (κ=0.84) for left ventricular ejection fraction to 100% (κ=1) for valvular disease. Image quality was graded as good in 79% of parasternal long-axis, 77% of parasternal short-axis and 64% of apical four-chamber views. The chance-corrected κ coefficients indicated fair to moderate agreement (κ=0.28-0.51) for the image quality parameters. There was good agreement on diagnosis between the focused method and standard echocardiography (78% agreement), compared in 36 participants. The focused method accurately identified cardiac abnormalities in pregnant women and could be used for screening cardiac problems in obstetric settings.

Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact.

BackgroundIn low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training programme locally.MethodsThis was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were assessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa >0.6 indicative of good inter-rater agreement.ResultsKnowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties.ConclusionsAlthough knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives.

Focus-assessed transthoracic echocardiography: Implications in perioperative and intensive care

Transthoracic echocardiography is a potent and appealing diagnostic tool by virtue of rapidity, noninvasiveness, and repeatability. Focus-assessed transthoracic echocardiography (FATE) forms quick guidance to interpret the echocardiographic information and relates it to the clinical context. It can be applied in the perioperative period, intensive care units (ICUs), and emergency situations, in trauma and as resuscitation aids. FATE intents to assess cardiac function including contractility, chamber size and hypertrophy, valvular dysfunction, cardiac tamponade, and pericardial and pleural effusions. Thence, FATE has become a quintessential scanning tool perioperatively and in ICUs.

Use of focus assessed transthoracic echocardiography (FATE) in the veterinary emergency room

ABSTRACT: The use of bedside focus assessed transthoracic echocardiography (FATE) is widespread in human medicine, and the potential for veterinary medicine has only recently been investigated. Focused echocardiographic examination can be beneficial in critically ill patients compared to other bedside diagnostic methods, as well as facilitating rapid therapeutic approaches in the emergency room. The aim of this review is to discuss FATE and identify its main applications in veterinary medicine. In this context, FATE has proved to be benefical even when carried out by a non-cardiologist physician or veterinarian. However, a few references on this subject exist in the veterinary literature and there is still a need for standardization of this technique for use in animals.

Evaluation of Postgraduates Following Implementation of a Focus Assessed Transthoracic Echocardiography (FATE) Training Course-A Pilot Study.

At our institution, implementation of a formal training course in Basic Focus Assessed Transthoracic Echocardiography (FATE) was associated with an improvement in anesthesia trainees’ ability to obtain transthoracic echocardiography (TTE) images. Total image acquisition scores improved by a median (Q1, Q3) 9.1 (2.9,14.7) percentage points from pre-to post-hands-on FATE course (n=20; p=0.001). Participants who returned for a subsequent assessment 5 months following the course demonstrated a median (Q1, Q3) 18.0 (9.1,22.1) percentage point improvement from their pre-course total image acquisition scores (n=11; p=0.002). This pilot study established the feasibility of our program and results suggest that the basic FATE course can be used to teach trainees TTE quickly, effectively, and with significant retention.

Intraoperative Transthoracic Echocardiography is a Feasible Technique Used in Morbidly Obese Patients for Non-Invasive Cardiovascular Monitoring

Background and objectives: To evaluate the feasibility of an abbreviated focus-assessed transthoracic echocardiography protocol in morbidly obese patients. The purpose of this study was to evaluate whether good images could be obtained from this particularly difficult group of patients for whom acoustic imaging is often poor. Heart imaging could be helpful for cardiopulmonary screening and real-time monitoring. Materials and methods: The study included 106 morbidly obese patients, who were undergoing laparoscopic bariatric surgery. The mean patient age was 32 years (range 21- 52), and there were 35 males. The parasternal long and short axes, apical 4 and 5 chambers were evaluated. Results: In 95% of the patients, at least one view was obtained. In 78% two views were obtained and in 31% of the patients, all views and measurements could be performed. Discussion: In obese patients, the major advantage of having a non-invasive cardiac monitoring device is the ability to perform anesthesia delivery. Conclusion: Focused echocardiogaphy examination performed by anesthesiologists in the intraoperative period of morbid obese patients is feasible for almost all patients. Echocardiography offers non-invasiveness and speed for assessing the hemodynamic state and heart function of an obese patient. The image quality of the heart is sufficient to undergo interpretation and, therefore can contribute to intraoperative clinical decision-making

Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of low risk Pulmonary Embolism in Emergency Department

A diagnosis of Pulmonary Embolism (PE) is difficult that may be missed because of non specific clinical presentation. However, early diagnosis is fundamental, since immediate treatment is highly effective. Thus, with the availability of ultrasound machine in Emergency Department (ED) can help Emergency Physician to diagnose PE by using Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of PE in low risk patient before proceed with the gold standard investigation which is CT Pulmonary Angiogram (CTPA). We believed this case was likely to be repeated on some readers' clinical practice and this procedure is an appropriate option to consider in such cases. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16101 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 459-461

Focus assessed transthoracic echocardiography (FATE) to diagnose pleural effusions causing haemodynamic compromise

The clinical assessment of patients with respiratory and circulatory problems can be complex, time consuming and have a high incidence of error. Bedside transthoracic ultrasound (US) is a useful adjunctive test in the evaluation of acutely unstable patients. This case series describes the use of the Focus Assessed Transthoracic Echocardiography (FATE) protocol to diagnose unsuspected pleural collections of fluid and how drainage significantly contributes to the haemodynamic improvement seen in these patients.

Perioperative Use of Focus Assessed Transthoracic Echocardiography (FATE)

Perioperative Use of Focus Assessed Transthoracic Echocardiography (FATE)

Limited intervention improves technical skill in focus assessed transthoracic echocardiography among novice examiners

BackgroundPrevious studies addressing teaching and learning in point-of-care ultrasound have primarily focussed on image interpretation and not on the technical quality of the images. We hypothesized that a limited intervention of 10 supervised examinations would improve the technical skills in Focus Assessed Transthoracic Echocardiography (FATE) and that physicians with no experience in FATE would quickly adopt technical skills allowing for image quality suitable for interpretation.MethodsTwenty-one physicians with no previous training in FATE or echocardiography (Novices) participated in the study and a reference group of three examiners with more than 10 years of experience in echocardiography (Experts) was included. Novices received an initial theoretical and practical introduction (2 hours), after which baseline examinations were performed on two healthy volunteers. Subsequently all physicians were scheduled to a separate intervention day comprising ten supervised FATE examinations. For effect measurement a second examination (evaluation) of the same two healthy volunteers from the baseline examination was performed.ResultsAt baseline 86% of images obtained by novices were suitable for interpretation, on evaluation this was 93% (p = 0.005). 100% of images obtained by experts were suitable for interpretation. Mean global image rating on baseline examinations was 70.2 (CI 68.0-72.4) and mean global image rating after intervention was 75.0 (CI 72.9-77.0), p = 0.0002. In comparison, mean global image rating in the expert group was 89.8 (CI 88.8-90.9).ConclusionsImprovement of technical skills in FATE can be achieved with a limited intervention and upon completion of intervention 93% of images achieved are suitable for clinical interpretation.

Basic FATE (Focus Assessed Transthoracic Echocardiography)

Basic FATE (Focus Assessed Transthoracic Echocardiography)

Focus Assessed Transthoracic Echocardiography (FATE)

Focus Assessed Transthoracic Echocardiography (FATE)

Focus assessed transthoracic echocardiography (FATE)

The course is aimed at any doctor involved in the care of critically ill patients, whether in the intensive care unit, operating theatre, emergency department, or other area. All the candidates on the 2010 course were anaesthetists, but the course is also suitable for emergency or acute medicine physicians or intensivists. I was a specialty trainee year 4 in anaesthesia when I went on the course; the other participants were fellow registrars or consultants. I was keen to start learning how to use echocardiography to assess the critically ill patient. This course was aimed at people with little or no previous skill in echocardiography; and as well as covering the basic foundations of echocardiography it quickly allowed me to gain the skills needed to use echocardiography to assess real patients, initially with supervision. Although …

Pneumoperitoneum diagnosed as an incidental finding using focus assessed transthoracic echocardiography: a case report

Abstract Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted to a coronary unit with a sudden onset of constant left sided thoracic pain. At position 1 (subcostal) of the FATE protocol, the heart and liver could not be visualised. Instead the peritoneum could be seen as a hyperechoic stripe, corresponding horizontal reverberation artefacts was visible under the peritoneal line. Based on these findings, a conventional X-ray image of the abdomen was taken with the patient in the left lateral decubitus position, confirming the diagnosis of pneumoperitoneum. Conclusion This demonstrates how systematic use of FATE combined with knowledge of sonographic patterns in extracardial diseases can directly ensure the patients a quicker diagnosis and treatment.

Focus-assessed transthoracic echocardiography in the sitting position: two life-saving cases

Focus-Assessed Transthoracic Echocardiography (FATE) is a point-of-care ultrasound protocol allowing the fast evaluation of the cardio-pulmonary status. It has been well established that patients with an exacerbation of chronic obstructive lung disease and lung oedema benefit from the sitting position. These and other medical emergency situations may prevent patients from attaining the supine position, thus precluding standard echocardiography. Portable ultrasound machines with a wide range of different probes are now available at limited costs. This allows the physician to bring point-of-care ultrasound to the patient in almost any location. We present two cases of severely ill patients where FATE was performed in the sitting position with decisive impact on subsequent therapy.

New pocket echocardiography device is interchangeable with high‐end portable system when performed by experienced examiners

Cardiovascular status is a crucial determinant in the pre-operative assessment of patients for surgery as well as for the handling of patients with acute illness. We hypothesized that focus-assessed transthoracic echocardiography (FATE) could be performed with the subject in the semi-recumbent position. The aim was also to test whether the image quality of Vscan is interchangeable with a conventional high-quality portable echocardiography system. Furthermore, we evaluated the time needed to achieve an interpretable four-chamber view and to complete a full FATE examination. Sixty-one subjects were included. All subjects were examined in accordance with the FATE protocol in the semi-recumbent position on two different systems: the novel Vscan pocket device and the high-quality portable Vivid i system. Two evaluations were performed. In group A (n=30), the focus was on image quality. In group B (n=31), the focus was on the time consumed. Group A: All patients (100%) had at least one image suitable for interpretation and no significant difference in image quality (P=0.32) was found between the two different systems. Group B: The mean value for the total time consumed for a full FATE was 69.3 s (59.8-78.8) on the Vscan and 63.7s (56.7-70.8) on the Vivid i, with no significant difference among the scanners (P=0.08). The Vscan displays image quality interchangeable with larger and more expensive systems. The apparatus is well suited for performing a FATE examination in a 1-day surgery setting and could very well also be applicable in almost any situation involving patients with acute illness.

Focus assessed transthoracic echocardiography (FATE) in aortic valve replacement

Focus assessed transthoracic echocardiography (FATE) in aortic valve replacement