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Chapter 3 - FoCUSed Cardiac Ultrasound for Cardiac Disorders

Published online by Cambridge University Press:  26 January 2024

David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Grace Lim
Affiliation:
University of Pittsburgh
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Summary

Ultrasonography is a safe, relatively inexpensive, and portable imaging modality. With the increasing availability of mobile, portable, and pocket-sized ultrasound machines, point-of-care transthoracic echocardiography has become a bedside tool to serve in medical emergencies and in peri-operative settings to assess the hemodynamically unstable obstetric patient in a timely fashion. In managing obstetric critical illness, some characteristics of pregnant women facilitate a focused cardiac examination, including anterior and left lateral displacement of the heart, spontaneous ventilation, and familiarity with ultrasound use. It supplements the physical examination, basic investigations, and aids in the diagnosis of significant cardiac pathology. While many acronyms exist, such as bedside echocardiography, point-of-care echocardiography, hand-held echocardiography, or goal-directed echocardiography, national and international scientific bodies have agreed on the terminology “focused cardiac ultrasound” or FoCUS. This chapter provides an overview of the definition, techniques, and diagnostic aims of a FoCUS examination and its clinical applications in obstetric cardiac disease. The chapter concludes by summarizing certification standards and training requirements.

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Publisher: Cambridge University Press
Print publication year: 2024

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References

Holm, JH, Frederiksen, CA, Juhl-Olsen, P, et al. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesth Analg 2012;115:10291032.CrossRefGoogle ScholarPubMed
Spencer, KT, Kimura, BJ, Korcarz, CE, et al. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013;26:567581.Google Scholar
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.Google Scholar
Gregory, JS. Focused assessment with sonography for trauma: ultrasound for abdominal trauma evaluation. Atlas Oral Maxillofac Surg Clin North Am 2015;23:131136.Google Scholar
Seif, D, Perera, P, Mailhot, T, et al. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Crit Care Res Pract 2012;2012:503254. https://doi.org/10.1155/2012/503254Google Scholar
Breitkreutz, R, Price, S, Steiger, HV, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation 2010;81:15271533.Google Scholar
Dennis, AT. Transthoracic echocardiography in obstetric anaesthesia and obstetric critical illness. Int J Obstet Anesth 2011;20:160168.Google Scholar
Bøtker, MT, Vang, ML, Grøfte, T, et al. Implementing point-of-care ultrasonography of the heart and lungs in an anesthesia department. Acta Anaesthesiol Scand 2017;61:156165.Google Scholar
Holm, JH, Frederiksen, CA, Juhl-Olsen, P, et al. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesth Analg 2012;115:10291032.Google Scholar
Soubra, SH, Guntupalli, KK. Critical illness in pregnancy: an overview. Crit Care Med 2005;33:S248255.Google Scholar
Dennis, AT, Solnordal, CB. Acute pulmonary oedema in pregnant women: pulmonary oedema in pregnancy. Anaesthesia 2012;67:646659.Google Scholar
Silva, S, Biendel, C, Ruiz, J, et al. Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice. Chest 2013;144: 859865.Google Scholar
Bataille, B, Riu, B, Ferre, F, et al. Integrated use of bedside lung ultrasound and echocardiography in acute respiratory failure: a prospective observational study in ICU. Chest 2014;146:15861593.Google Scholar
Gallard, E, Redonnet, J-P, Bourcier, J-E, et al. Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea. Am J Emerg Med 2015;33:352358.Google Scholar
Zieleskiewicz, L, Lagier, D, Contargyris, C, et al. Lung ultrasound-guided management of acute breathlessness during pregnancy. Anaesthesia 2013;68:97101.Google Scholar
Zieleskiewicz, L, Bouvet, L, Einav, S, et al.Diagnostic point-of-care ultrasound: applications in obstetric anaesthetic management. Anaesthesia 2018;73:12651279.Google Scholar
Tsou, P-Y, Kurbedin, J, Chen, Y-S, et al. Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: a systematic review and meta-analysis. Resuscitation 2017:114:9299.Google Scholar
Lalande, E, Burwash-Brennan, T, Burns, K, et al. (SHOC investigators) Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHOC investigators. Resuscitation 2019;139:159166.Google Scholar
Labovitz, AJ, Noble, VE, Bierig, M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 2010;23:12251230.CrossRefGoogle ScholarPubMed
Link, MS, Berkow, LC, Kudenchuk, PJ, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S444464.Google Scholar
Soar, J, Berg, KM, Andersen, LW, et al. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2020;156:A80119.Google Scholar
Zelop, CM, Einav, S, Mhyre, JM, et al. Characteristics and outcomes of maternal cardiac arrest: a descriptive analysis of Get with the guidelines data. Resuscitation 2018;132:1720.Google Scholar
Mhyre, JM, Tsen, LC, Einav, S, et al. Cardiac arrest during hospitalization for delivery in the United States, 1998–2011. Anesthesiology 2014;120:810818.Google Scholar
Helviz, Y, Einav, S. Maternal cardiac arrest. Curr Opin Anaesthesiol 2019;32:298306.Google Scholar
Jones, AE, Tayal, VS, Sullivan, DM, et al. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med 2004;32:17031708.Google Scholar
Pomero, F, Dentali, F, Borretta, V, et al. Accuracy of emergency physician-performed ultrasonography in the diagnosis of deep-vein thrombosis: a systematic review and meta-analysis. Thromb Haemost 2013;109:137145.Google Scholar
Ramsingh, D, Bronshteyn, YS, Haskins, S, et al. Perioperative point-of-care ultrasound. Anesthesiology 2020;132:908916.Google Scholar
Barber, RL, Fletcher, SN. A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility. Anaesthesia 2014;69:764776.Google Scholar
Finfer, S, Liu, B, Taylor, C, et al. (SAFE TRIPS Investigators) Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units. Crit Care 2010;14:R185. https://doi.org/10.1186/cc9293Google Scholar
Boyd, JH, Forbes, J, Nakada, T, et al. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011;39:259265.Google Scholar
Holodinsky, JK, Roberts, DJ, Ball, CG, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care 2013;17:R249.CrossRefGoogle ScholarPubMed
Bentzer, P, Griesdale, DE, Boyd, J, et al. Will this hemodynamically unstable patient respond to a bolus of intravenous fluids? JAMA 2016;316:1298.CrossRefGoogle ScholarPubMed
Beigel, R, Cercek, B, Luo, H, et al. Noninvasive evaluation of right atrial pressure. J Am Soc Echocardiogr 2013;26:10331042.Google Scholar
Brun, C, Zieleskiewicz, L, Textoris, J, et al. Prediction of fluid responsiveness in severe preeclamptic patients with oliguria. Intensive Care Med 2013;39:593600.CrossRefGoogle ScholarPubMed
Zieleskiewicz, L, Noel, A, Duclos, G, et al. Can point-of-care ultrasound predict spinal hypotension during caesarean section? A prospective observational study. Anaesthesia 2018;73:1522.Google Scholar
Main, EK, McCain, CL, Morton, CH, et al. Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstet Gynecol 2015;125:938947.Google Scholar
Lisonkova, S, Joseph, KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol 2013;209:544.e1–544.e12.Google Scholar
ACOG. Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol 2019;133:1. https://doi.org/10.1097/AOG.0000000000003018Google Scholar
Young, P, Johanson, R. Haemodynamic, invasive and echocardiographic monitoring in the hypertensive parturient. Best Pract Res Clin Obstet Gynaecol 2001;15:605622.Google Scholar
Dennis, AT, Castro, JM. Transthoracic echocardiography in women with treated severe pre-eclampsia. Anaesthesia 2014;69:436444.Google Scholar
Dennis, AT, Castro, J, Carr, C, et al. Haemodynamics in women with untreated pre-eclampsia. Anaesthesia 2012;67:11051118.Google Scholar
Melchiorre, K, Thilaganathan, B. Maternal cardiac function in preeclampsia. Curr Opin Obstet Gynecol 2011;23:440447.Google Scholar
Jambrik, Z, Gargani, L, Adamicza, Á, et al. B-Lines quantify the lung water content: a lung ultrasound versus lung gravimetry study in acute lung injury. Ultrasound Med Biol 2010;36:20042010.Google Scholar
Gargani, L, Lionetti, V, Di Cristofano, C, et al. Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Crit Care Med 2007;35:27692774.Google Scholar
Ortner, CM, Krishnamoorthy, V, Neethling, E, et al. Point-of-care ultrasound abnormalities in late-onset severe preeclampsia: prevalence and association with serum albumin and brain natriuretic peptide. Anesth Analg 2019;128:12081216.Google Scholar
Zieleskiewicz, L, Contargyris, C, Brun, C, et al. Lung ultrasound predicts interstitial syndrome and hemodynamic profile in parturients with severe preeclampsia. Anesthesiology 2014;120:906914.Google Scholar
Arbelot, C, Dexheimer Neto, FL, Gao, Y, et al. (APECHO Study Group). Lung ultrasound in emergency and critically ill patients. Number of supervised exams to reach basic competence. Anesthesiology 2020;132:899907.Google Scholar
Task Force for the Management of COVID-19 of the European Society of Cardiology. ESC guidance for the diagnosis and management of CV disease during the COVID-19 pandemic: part 1 – epidemiology, pathophysiology, and diagnosis. Eur Heart J 2022;43:1033–1058.Google Scholar
Mercedes, BR, Serwat, A, Naffaa, L, et al. New-onset myocardial injury in pregnant patients with coronavirus disease 2019: a case series of 15 patients. Am J Obstet Gynecol 2021;224:387.e1–387.e9.Google Scholar
Juusela, A, Nazir, M, Gimovsky, M. Two cases of coronavirus 2019–related cardiomyopathy in pregnancy. Am J Obstet Gynecol MFM 2020;2:100113.Google Scholar
Abou-Ismail, MY, Diamond, A, Kapoor, S, et al. The hypercoagulable state in COVID-19: incidence, pathophysiology, and management. Thromb Res 2020;194:101115.Google Scholar
Miniati, M, Monti, S, Pratali, L, et al. Value of transthoracic echocardiography in the diagnosis of pulmonary embolism: results of a prospective study in unselected patients. Am J Med 2001;110:528535.Google Scholar
Flower, L, Dempsey, M, White, A, et al. Training and accreditation pathways in critical care and perioperative echocardiography. J Cardiothorac Vasc Anesth 2021;35:235247.Google Scholar
Expert Round Table on Echocardiography in ICU. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med. 2014;40(5):654666. https://doi.org/10.1007/s00134-014-3228-5. Epub March 11, 2014.Google Scholar

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