Focused Cardiac Ultrasound for Rapid Hemodynamic Assessment: A Primer for Vascular and Interventional Radiologists

Area of Science:

• Critical Care Medicine
• Cardiovascular Imaging
• Interventional Radiology

Background:

• Interventional Radiology (IR) now includes periprocedural and inpatient care for critically ill patients.
• Acute hypotension and shock are common in IR patients, stemming from causes like hemorrhage, sepsis, myocardial infarction, and pulmonary embolism.
• A key IR skillset must include the accurate evaluation of acutely deteriorating patients.

Purpose of the Study:

• To present a primer on performing a systematic focused cardiac ultrasound (FOCUS) examination.
• To enable rapid bedside assessment of critically ill patients in IR experiencing acute hypotension.
• To guide the determination of shock etiology through sonographic evaluation of cardiac and inferior vena cava parameters.

Main Methods:

• Systematic focused cardiac ultrasound examination.
• Bedside sonographic assessment of the heart and inferior vena cava.
• Evaluation of ventricular function, pericardial effusion, tamponade physiology, intravascular volume, and structural cardiac pathology.

Main Results:

• Focused cardiac ultrasound provides rapid bedside assessment of critical hemodynamic parameters.
• Sonographic findings can differentiate causes of shock, including hypovolemia, cardiac dysfunction, and obstructive causes like pulmonary embolism or tamponade.
• The technique allows for timely identification of structural cardiac abnormalities impacting hemodynamic stability.

Conclusions:

• Focused cardiac ultrasound is an essential skill for Interventional Radiologists managing critically ill patients.
• This goal-directed sonographic approach facilitates rapid diagnosis and management of shock in the IR setting.
• Integrating FOCUS into IR practice improves patient care by enabling prompt etiological diagnosis of acute hypotension.