Training in basic hand-held echocardiography for the critical care: not such a difficult task

Z Belamaric, D Nagore, JP Jimeno, A Bilbao,  T Garth, K Plummer

Department of Perioperative Medicine, St. Bartholomew’s Hospital, London, UK

Background and Goal of Study

In the last decade focus assessment ultrasound protocols (FAST, FATE, RUSH,...) have been

developed. Due to technological development simple scans can be delivered by palm top devices.

This study is designed to see if the skills needed to provide basic hand-held echocardiography in

the critical care environment can be taught effectively.

Materials and methods

12 echocardiography naive junior doctors received a single day course, consisting of lectures,

simulation work and familiarisation with the hand held V scanners. They had access to the V

scanners and a mentor for a 6 week period. After this period they were evaluated to assess

knowledge and skills learnt and retained by together a senior ICU Anaesthetist and a senior

Cardiologist.

The following categories were assessed and classified in a scale of 1 to 5, where (1) poor, (2) fair,

(3) good, (4) very good and (5) excellent :

1. Image acquisition of the standard ECHO views and obtaining the windows suitable for

interpretation

2. LV assessment of size and function

3. RV function assessment

4. MV and MR assessment

5. Aortic Valve assessment and to identify AS, AR and valve thickening

6. Pericardial effusion assessment

7. Filling status / volume status assessment including IVC measurement

8. Overall Impression of the junior doctor knowledge

Results

The mean score of the overall impression of the junior doctors knowledge before and after the

course was 1 and 3.4 respectively (p value<0.0001).

In the categories of image acquisition, LV assessment and MV assessment the mean score

achieved was 3.4 which was compliant with the mean score of 3.4 in the overall impression of the

junior doctor knowledge (p value=1).

Pericardial effusion and AV assessment mean scores were 3.7 and 3.2 respectively which in

comparison with mean score of overall knowledge showed no statistical significance (p=0.2 and

p=0.5).

Mean RV and filling status assessment scores were 2.8 and 2.9 respectively, and showed a

statistically significant difference with the overall impression of junior doctor knowledge (p= 0.01

and p=0.02 respectively).

Conclusion

Junior doctors have significantly improved overall knowledge in the basic echocardiography after

the course. The level of knowledge was equally distributed in all categories except in RV and filling

status assessment where students showed lower skills level. Therefore, appropriate clinical and

imaging supervisory pathways should always be available where this kind of activity is undertaken.