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Intraoperative Point of Care Transthoracic Echocardiography: Feasibility and Implications for Education
Jonathan M Curley1, Jessica L Guerra1, Emily H Garmon1
1The following authors are at the University of Virginia, Charlottesville, VA: Jonathan M. Curley is an Assistant Professor of Anesthesiology in the Department of Anesthesiology and Critical Care Medicine; and Siny Tsang is a Biostatistician in the Department of Anesthesiology. The following authors are at Baylor Scott & White Medical Center, Baylor College of Medicine, Temple, TX: Jessica L. Guerra is a Cardiothoracic Anesthesiology Fellow; Emily H. Garmon is an Associate Professor of Anesthesiology; Craig J. Lilie is an Assistant Professor of Anesthesiology; and William C. Culp, Jr. is a Professor of Anesthesiology.
Background:
Incorporating intraoperative ultrasound education into anesthesiology graduate medical training may benefit both trainees and the field of anesthesiology.
Methods:
This study describes the successful integration of intraoperative ultrasound training into an existing Focused Cardiac Ultrasound (FoCUS) curriculum. A retrospective analysis of educational logs from 4 postgraduate year 4 anesthesiology residents (exam n = 160) was conducted to determine the most accessible intraoperative FoCUS views, success rates of image acquisition by surgical region, and impact of abdominal insufflation and Trendelenburg positioning on success rates.
Results:
Parasternal views had the highest probability of successful image acquisition (parasternal long axis [PLA] odds ratio [OR] = 16.36 and parasternal midpapillary short axis [PSA] OR = 21.98 compared with subcostal 4-chamber [SC]). Extremity surgeries offered the highest success rates (52% for SC to 92.5% for PLA), whereas thoracic surgery had the lowest (9.1% for SC to 63.6% for PSA). Trendelenburg positioning increased the odds of successful image acquisition in PLA or PSA views (OR, 3.58; 95% confidence interval, 1.4-9.11).
Conclusions:
Integrating intraoperative ultrasound education into existing FoCUS curricula is feasible. Educators should consider emphasizing parasternal views, which are the most accessible to anesthesia clinicians, consider the higher success rates in extremity surgeries for complete examinations, and recognize that Trendelenburg positioning may enhance image optimization.
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