Pilot Study Assessing Feasibility of Focused Newborn Cardiac Ultrasound by Transport Team Members to Identify Hypoxemic Congenital Heart Disease
Related Experiment Video
Updated: Jan 17, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Brittany Shutes1, Jonathan A Wheeler2, Charles McCombs3
1Department of Pediatrics, Cardiology and Intensive Care Medicine, Nationwide Children's Hospital, Columbus, OH.
Objective:
Hypoxemia is a common presentation of neonatal critical illness. Identifying critical congenital heart disease (CHD) causing hypoxemia is pivotal in determining immediate medical management. In this work, the preliminary results from development of a transport team-focused cardiac ultrasound (US) protocol were presented.
Methods:
Phase 1 involved baseline survey of transport team motivation and prior experience followed by structured education and hands-on simulation sessions to teach the basics of cardiac anatomy and US. Participants complete pre- and post-education knowledge assessments. In phase 2, participants performed supervised bedside US on hospitalized infants to practice skills, familiarize themselves with the handheld US device, and learn the focused cardiac US protocol. The US images were compared with a recent comprehensive echocardiogram and assessed for image quality and diagnostic certainty by 2 pediatric cardiologists.
Results:
A total of 25 transport team members completed paired pre- and post-testing in phase 1. They had high team member motivation to improve US skills and cardiac anatomy knowledge and demonstrated improved post-education scoring with median score increasing from 20/43 (47%) (interquartile range [IQR]: 17-25) to 34/43 (79%) (IQR: 34-41.5) (P < .05). In phase 2, 17 transport members completed 42 scans on 14 unique infants, 10 with CHD. Of 42 scans, 39 (93%) had sufficient image quality to make a diagnosis, with 37 (88%) having "high" diagnostic certainty and 36 (86%) matched complete transthoracic echocardiogram, without missed diagnosis. The median completion time was 17 (IQR: 12.8-20.6) minutes.
Conclusion:
The first 2 phases of this study have demonstrated that transport team members can use handheld US technology to obtain timely and sufficient quality cardiac images to allow for identifying and triaging of CHD in infants. This novel, resource-conscious application has the potential to streamline the care of hypoxemic newborns after undergoing protocol efficiency refinement, independent proficiency testing, and study of remote application.
