Evidence: Critical Care Echo
A decade of progress in critical care echocardiography: a narrative review. Vieillard-Baron et al. Intensive Care. 2019.
| Clinical scenario | Potential benefit |
|---|---|
| Hospital admission | Improved diagnostic accuracy when it is added to history and physical examination |
| Screening point-of-care exam | Reliable assessment of LV systolic function Reliable assessment for pericardial fluid Ability to screen for major RV dysfunction or valvulopathy |
| Shock or hypotension of unclear etiology: early phase | Faster time to diagnosis on average Ability to alter patient management plan in a majority of cases |
| Shock or hypotension of unclear etiology: later phase | Less intravenous fluid administration Faster determination of shock etiology |
| Trauma | Faster detection of pericardial tamponade Reduced time to operative management in pericardial tamponade Potential mortality benefit in pericardial tamponade |
| Cardiac arrest | Potential to disclose reversible etiologies Detection of cardiac standstill with associated very poor prognosis |
| Septic shock | Detection of myocardial dysfunction Prognostic value where myocardial suppression is discovered |
| ARDS/complex mechanical ventilation | Detection of acute cor pulmonale Assessment of heart–lung interactions Titration of PEEP, prone positioning, and recruitment maneuvers |
| Hemodynamic monitoring | Estimation of useful values such as SV and CO Advanced assessment of volume responsiveness, including: Change in SV with PLR or fluid bolus Respiratory variability of the SVC |
| Liberation from mechanical ventilation | Better prediction of extubation success Better understanding of the etiology of weaning failure |
| Perioperative care: non-cardiac surgery | Preoperative CCE often useful for anesthetic and critical care triage Perioperative CCE useful for troubleshooting emergencies |
| Mechanical circulatory support | TEE is the gold standard for correct cannula positioning TEE or TTE useful for troubleshooting emergencies and weaning |
This narrative review from Vieillard et al describes the development and growth of critical care echo over the past decade. CCE is now well established as an important diagnostic and monitoring tool in critically unwell patients. Its use covers all stages of care for critical care patients right from presentation in the emergency department to admission and stay on the ICU. Its importance in circulatory management, especially in patients with mechanical circulatory support cannot be ignored. The table above summarizes some of the important applications of echo in critical care.
Practice Guidelines for CCE from the Society of Critical Care Medicine are available here. Accreditation exams are available by the National Board of Echocardiography (NBE). The syllabus for the exams is available here.