Intraoperative Point of Care Transthoracic Echocardiography: Feasibility and Implications for Education.

Abstract

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.