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Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit.
J Cardiothorac Vasc Anesth. 2020 Apr 20 [Online ahead of print]JC

Abstract

OBJECTIVES

Rescue point-of-care ultrasound (r-POCUS) in critical care medicine has revolutionized the management of critically ill patients with hemodynamic instability. However, clinical studies on its use among high-risk cardiac patients still are limited. The authors aimed to assess the utility of r-POCUS for managing high-risk cardiac patients in a mixed cardiac-surgical and cardiac-medical intensive care unit (ICU) in a quaternary care hospital by reviewing the indications and findings of r-POCUS and subsequent effect on patient management.

DESIGN

Retrospective observational study.

DESIGN

Single institution, quaternary care hospital.

PARTICIPANTS

The study comprised 189 consecutive r-POCUS examinations performed in a cardiac medical and surgical ICU.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

r-POCUS was performed on 141 patients. Common indications for r-POCUS included hypotension (n = 93 [49%]), assessment of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (n = 33 [17%]), arrhythmias (n = 13 [7%]), abnormal pulmonary artery catheter values (n = 11 [6%]), and ischemic electrocardiogram changes (n = 10 [5%]). Cardiac pathology was positive in 129 (68%) of the rescue examinations. Common reported pathologies included left ventricular dysfunction (n = 47 [25%]), right ventricular dysfunction (n = 52 [28%]), hypervolemia (n = 13 [7%]), hypovolemia (n = 25 [13%]), pericardial effusion/tamponade (n = 21 [11%]), and ECMO/ventricular assist device cannula malposition (n = 9 [5%]). Seventy-five percent of the rescue examinations resulted in medical and surgical interventions, including fluid resuscitation (n = 25 [13%]), diuresis (n = 14 [7%]), ionotropic support (n = 23 [12%]), surgical intervention in the operating room (n = 21 [11%]), surgical intervention at the bedside (n = 8 [4%]), ECMO initiation (n = 15 [8%]), and ECMO/ventricular assist device cannula/setting adjustment (n = 12 [6%]).

CONCLUSION

In this retrospective study, r-POCUS performed by attending intensivists resulted in diverse findings and was associated with rapid changes in clinical management of patients in a high-acuity, mixed cardiac-surgical and cardiac-medical ICU.

Authors+Show Affiliations

Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA; Heart Center Intensive Care Unit, Massachusetts General Hospital, Boston, MA.Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA; Heart Center Intensive Care Unit, Massachusetts General Hospital, Boston, MA. Electronic address: kshelton@mgh.harvard.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32417007

Citation

Lu, Shu Y., et al. "Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit." Journal of Cardiothoracic and Vascular Anesthesia, 2020.
Lu SY, Dalia AA, Cudemus G, et al. Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit. J Cardiothorac Vasc Anesth. 2020.
Lu, S. Y., Dalia, A. A., Cudemus, G., & Shelton, K. T. (2020). Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit. Journal of Cardiothoracic and Vascular Anesthesia. https://doi.org/10.1053/j.jvca.2020.03.053
Lu SY, et al. Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit. J Cardiothorac Vasc Anesth. 2020 Apr 20; PubMed PMID: 32417007.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit. AU - Lu,Shu Y, AU - Dalia,Adam A, AU - Cudemus,Gaston, AU - Shelton,Kenneth T, Y1 - 2020/04/20/ PY - 2020/02/08/received PY - 2020/03/27/revised PY - 2020/03/29/accepted PY - 2020/5/18/entrez PY - 2020/5/18/pubmed PY - 2020/5/18/medline KW - cardiac critical care medicine KW - point-of-care ultrasound KW - rescue echocardiography JF - Journal of cardiothoracic and vascular anesthesia JO - J. Cardiothorac. Vasc. Anesth. N2 - OBJECTIVES: Rescue point-of-care ultrasound (r-POCUS) in critical care medicine has revolutionized the management of critically ill patients with hemodynamic instability. However, clinical studies on its use among high-risk cardiac patients still are limited. The authors aimed to assess the utility of r-POCUS for managing high-risk cardiac patients in a mixed cardiac-surgical and cardiac-medical intensive care unit (ICU) in a quaternary care hospital by reviewing the indications and findings of r-POCUS and subsequent effect on patient management. DESIGN: Retrospective observational study. DESIGN: Single institution, quaternary care hospital. PARTICIPANTS: The study comprised 189 consecutive r-POCUS examinations performed in a cardiac medical and surgical ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: r-POCUS was performed on 141 patients. Common indications for r-POCUS included hypotension (n = 93 [49%]), assessment of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (n = 33 [17%]), arrhythmias (n = 13 [7%]), abnormal pulmonary artery catheter values (n = 11 [6%]), and ischemic electrocardiogram changes (n = 10 [5%]). Cardiac pathology was positive in 129 (68%) of the rescue examinations. Common reported pathologies included left ventricular dysfunction (n = 47 [25%]), right ventricular dysfunction (n = 52 [28%]), hypervolemia (n = 13 [7%]), hypovolemia (n = 25 [13%]), pericardial effusion/tamponade (n = 21 [11%]), and ECMO/ventricular assist device cannula malposition (n = 9 [5%]). Seventy-five percent of the rescue examinations resulted in medical and surgical interventions, including fluid resuscitation (n = 25 [13%]), diuresis (n = 14 [7%]), ionotropic support (n = 23 [12%]), surgical intervention in the operating room (n = 21 [11%]), surgical intervention at the bedside (n = 8 [4%]), ECMO initiation (n = 15 [8%]), and ECMO/ventricular assist device cannula/setting adjustment (n = 12 [6%]). CONCLUSION: In this retrospective study, r-POCUS performed by attending intensivists resulted in diverse findings and was associated with rapid changes in clinical management of patients in a high-acuity, mixed cardiac-surgical and cardiac-medical ICU. SN - 1532-8422 UR - https://www.unboundmedicine.com/medline/citation/32417007/Rescue_Echocardiography/Ultrasonography_in_the_Management_of_Combined_Cardiac_Surgical_and_Medical_Patients_in_a_Cardiac_Intensive_Care_Unit L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(20)30303-7 DB - PRIME DP - Unbound Medicine ER -
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