International evidence-based recommendations for focused cardiac ultrasound

Gabriele Via; Arif Hussain; Mike Wells; Robert Reardon; Mahmoud Elbarbary; Vicki E. Noble; James W. Tsung; Aleksandar N. Neskovic; Susanna Price; Achikam Oren-Grinberg; Andrew Liteplo; Ricardo Cordioli; Nitha Naqvi; Philippe Rola; Jan Poelaert; Tatjana Golob Guliĉ; Erik Sloth; Arthur Labovitz; Bruce Kimura; Raoul Breitkreutz; Navroz Masani; Justin Bowra; Daniel Talmor; Fabio Guarracino; Adrian Goudie; Wang Xiaoting; Rajesh Chawla; Maurizio Galderisi; Micheal Blaivas; Tomislav Petrovic; Enrico Storti; Luca Neri; Lawrence Melniker

doi:10.1016/j.echo.2014.05.001

International evidence-based recommendations for focused cardiac ultrasound

Gabriele Via, Arif Hussain, Mike Wells, Robert Reardon, Mahmoud Elbarbary, Vicki E. Noble, James W. Tsung, Aleksandar N. Neskovic, Susanna Price, Achikam Oren-Grinberg, Andrew Liteplo, Ricardo Cordioli, Nitha Naqvi, Philippe Rola, Jan Poelaert, Tatjana Golob Guliĉ, Erik Sloth, Arthur Labovitz, Bruce Kimura, Raoul BreitkreutzNavroz Masani, Justin Bowra, Daniel Talmor, Fabio Guarracino, Adrian Goudie, Wang Xiaoting, Rajesh Chawla, Maurizio Galderisi, Micheal Blaivas, Tomislav Petrovic, Enrico Storti, Luca Neri, Lawrence Melniker

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

317 Scopus citations

Abstract

Background Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. Methods The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. Results During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. Conclusions This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.

Original language	English (US)
Pages (from-to)	683.e1-683.e33
Journal	Journal of the American Society of Echocardiography
Volume	27
Issue number	7
DOIs	https://doi.org/10.1016/j.echo.2014.05.001
State	Published - Jul 2014

Bibliographical note

Funding Information:
Comment. Different specialties through their colleges and societies have started to publish detailed lists of competencies to be acquired, and even structured examinations are being contemplated for the extent of cardiac ultrasound knowledge and skills sets required for their specialists. Anesthesiologists took the lead among noncardiologists for training and examinations in transesophageal echocardiography as a result of collaborative work under the auspices of the ASE, the Society of Cardiovascular Anesthesiologists, and the European Association of CardioThoracic Anesthesiologists. Fellowship in cardiac anesthesiology now includes transesophageal echocardiography training and examinations administered respectively by the National Board of Echocardiography and by the European Association of CardioThoracic Anesthesiologists (jointly with the European Association of Cardiovascular Imaging). For FoCUS, however, the recognition for such recommendations was delayed, primarily because of different needs of various specialties. The American College of Chest Physicians published a comprehensive standard document on echocardiography and lung ultrasound, 30 followed by a consensus statement of the ASE and the American College of Emergency Physicians 32 and an ASE expert statement 34 clarifying the role of FoCUS, and limited versus comprehensive standard echocardiography, and also setting standards for competencies.

Keywords

Cardiac sonography
Cardiac ultrasound
Crit Care echocardiography
Critical ultrasound
Echocardiography
Emergency ultrasound
Evidence-based medicine
GRADE
Guideline
Point-of-care ultrasound
RAND

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Via, G., Hussain, A., Wells, M., Reardon, R., Elbarbary, M., Noble, V. E., Tsung, J. W., Neskovic, A. N., Price, S., Oren-Grinberg, A., Liteplo, A., Cordioli, R., Naqvi, N., Rola, P., Poelaert, J., Guliĉ, T. G., Sloth, E., Labovitz, A., Kimura, B., ... Melniker, L. (2014). International evidence-based recommendations for focused cardiac ultrasound. Journal of the American Society of Echocardiography, 27(7), 683.e1-683.e33. https://doi.org/10.1016/j.echo.2014.05.001

International evidence-based recommendations for focused cardiac ultrasound. / Via, Gabriele; Hussain, Arif; Wells, Mike; Reardon, Robert; Elbarbary, Mahmoud; Noble, Vicki E.; Tsung, James W.; Neskovic, Aleksandar N.; Price, Susanna; Oren-Grinberg, Achikam; Liteplo, Andrew; Cordioli, Ricardo; Naqvi, Nitha; Rola, Philippe; Poelaert, Jan; Guliĉ, Tatjana Golob; Sloth, Erik; Labovitz, Arthur; Kimura, Bruce; Breitkreutz, Raoul; Masani, Navroz; Bowra, Justin; Talmor, Daniel; Guarracino, Fabio; Goudie, Adrian; Xiaoting, Wang; Chawla, Rajesh; Galderisi, Maurizio; Blaivas, Micheal; Petrovic, Tomislav; Storti, Enrico; Neri, Luca; Melniker, Lawrence.

In: Journal of the American Society of Echocardiography, Vol. 27, No. 7, 07.2014, p. 683.e1-683.e33.

Research output: Contribution to journal › Article › peer-review

Via, G, Hussain, A, Wells, M, Reardon, R, Elbarbary, M, Noble, VE, Tsung, JW, Neskovic, AN, Price, S, Oren-Grinberg, A, Liteplo, A, Cordioli, R, Naqvi, N, Rola, P, Poelaert, J, Guliĉ, TG, Sloth, E, Labovitz, A, Kimura, B, Breitkreutz, R, Masani, N, Bowra, J, Talmor, D, Guarracino, F, Goudie, A, Xiaoting, W, Chawla, R, Galderisi, M, Blaivas, M, Petrovic, T, Storti, E, Neri, L & Melniker, L 2014, 'International evidence-based recommendations for focused cardiac ultrasound', Journal of the American Society of Echocardiography, vol. 27, no. 7, pp. 683.e1-683.e33. https://doi.org/10.1016/j.echo.2014.05.001

Via, Gabriele ; Hussain, Arif ; Wells, Mike ; Reardon, Robert ; Elbarbary, Mahmoud ; Noble, Vicki E. ; Tsung, James W. ; Neskovic, Aleksandar N. ; Price, Susanna ; Oren-Grinberg, Achikam ; Liteplo, Andrew ; Cordioli, Ricardo ; Naqvi, Nitha ; Rola, Philippe ; Poelaert, Jan ; Guliĉ, Tatjana Golob ; Sloth, Erik ; Labovitz, Arthur ; Kimura, Bruce ; Breitkreutz, Raoul ; Masani, Navroz ; Bowra, Justin ; Talmor, Daniel ; Guarracino, Fabio ; Goudie, Adrian ; Xiaoting, Wang ; Chawla, Rajesh ; Galderisi, Maurizio ; Blaivas, Micheal ; Petrovic, Tomislav ; Storti, Enrico ; Neri, Luca ; Melniker, Lawrence. / International evidence-based recommendations for focused cardiac ultrasound. In: Journal of the American Society of Echocardiography. 2014 ; Vol. 27, No. 7. pp. 683.e1-683.e33.

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title = "International evidence-based recommendations for focused cardiac ultrasound",

abstract = "Background Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. Methods The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. Results During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. Conclusions This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.",

keywords = "Cardiac sonography, Cardiac ultrasound, Crit Care echocardiography, Critical ultrasound, Echocardiography, Emergency ultrasound, Evidence-based medicine, GRADE, Guideline, Point-of-care ultrasound, RAND",

author = "Gabriele Via and Arif Hussain and Mike Wells and Robert Reardon and Mahmoud Elbarbary and Noble, {Vicki E.} and Tsung, {James W.} and Neskovic, {Aleksandar N.} and Susanna Price and Achikam Oren-Grinberg and Andrew Liteplo and Ricardo Cordioli and Nitha Naqvi and Philippe Rola and Jan Poelaert and Guliĉ, {Tatjana Golob} and Erik Sloth and Arthur Labovitz and Bruce Kimura and Raoul Breitkreutz and Navroz Masani and Justin Bowra and Daniel Talmor and Fabio Guarracino and Adrian Goudie and Wang Xiaoting and Rajesh Chawla and Maurizio Galderisi and Micheal Blaivas and Tomislav Petrovic and Enrico Storti and Luca Neri and Lawrence Melniker",

note = "Funding Information: Comment. Different specialties through their colleges and societies have started to publish detailed lists of competencies to be acquired, and even structured examinations are being contemplated for the extent of cardiac ultrasound knowledge and skills sets required for their specialists. Anesthesiologists took the lead among noncardiologists for training and examinations in transesophageal echocardiography as a result of collaborative work under the auspices of the ASE, the Society of Cardiovascular Anesthesiologists, and the European Association of CardioThoracic Anesthesiologists. Fellowship in cardiac anesthesiology now includes transesophageal echocardiography training and examinations administered respectively by the National Board of Echocardiography and by the European Association of CardioThoracic Anesthesiologists (jointly with the European Association of Cardiovascular Imaging). For FoCUS, however, the recognition for such recommendations was delayed, primarily because of different needs of various specialties. The American College of Chest Physicians published a comprehensive standard document on echocardiography and lung ultrasound, 30 followed by a consensus statement of the ASE and the American College of Emergency Physicians 32 and an ASE expert statement 34 clarifying the role of FoCUS, and limited versus comprehensive standard echocardiography, and also setting standards for competencies. ",

year = "2014",

month = jul,

doi = "10.1016/j.echo.2014.05.001",

language = "English (US)",

volume = "27",

pages = "683.e1--683.e33",

journal = "Journal of the American Society of Echocardiography",

issn = "0894-7317",

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number = "7",

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TY - JOUR

T1 - International evidence-based recommendations for focused cardiac ultrasound

AU - Via, Gabriele

AU - Hussain, Arif

AU - Wells, Mike

AU - Reardon, Robert

AU - Elbarbary, Mahmoud

AU - Noble, Vicki E.

AU - Tsung, James W.

AU - Neskovic, Aleksandar N.

AU - Price, Susanna

AU - Oren-Grinberg, Achikam

AU - Liteplo, Andrew

AU - Cordioli, Ricardo

AU - Naqvi, Nitha

AU - Rola, Philippe

AU - Poelaert, Jan

AU - Guliĉ, Tatjana Golob

AU - Sloth, Erik

AU - Labovitz, Arthur

AU - Kimura, Bruce

AU - Breitkreutz, Raoul

AU - Masani, Navroz

AU - Bowra, Justin

AU - Talmor, Daniel

AU - Guarracino, Fabio

AU - Goudie, Adrian

AU - Xiaoting, Wang

AU - Chawla, Rajesh

AU - Galderisi, Maurizio

AU - Blaivas, Micheal

AU - Petrovic, Tomislav

AU - Storti, Enrico

AU - Neri, Luca

AU - Melniker, Lawrence

N1 - Funding Information: Comment. Different specialties through their colleges and societies have started to publish detailed lists of competencies to be acquired, and even structured examinations are being contemplated for the extent of cardiac ultrasound knowledge and skills sets required for their specialists. Anesthesiologists took the lead among noncardiologists for training and examinations in transesophageal echocardiography as a result of collaborative work under the auspices of the ASE, the Society of Cardiovascular Anesthesiologists, and the European Association of CardioThoracic Anesthesiologists. Fellowship in cardiac anesthesiology now includes transesophageal echocardiography training and examinations administered respectively by the National Board of Echocardiography and by the European Association of CardioThoracic Anesthesiologists (jointly with the European Association of Cardiovascular Imaging). For FoCUS, however, the recognition for such recommendations was delayed, primarily because of different needs of various specialties. The American College of Chest Physicians published a comprehensive standard document on echocardiography and lung ultrasound, 30 followed by a consensus statement of the ASE and the American College of Emergency Physicians 32 and an ASE expert statement 34 clarifying the role of FoCUS, and limited versus comprehensive standard echocardiography, and also setting standards for competencies.

PY - 2014/7

Y1 - 2014/7

N2 - Background Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. Methods The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. Results During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. Conclusions This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.

AB - Background Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. Methods The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. Results During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. Conclusions This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.

KW - Cardiac sonography

KW - Cardiac ultrasound

KW - Crit Care echocardiography

KW - Critical ultrasound

KW - Echocardiography

KW - Emergency ultrasound

KW - Evidence-based medicine

KW - GRADE

KW - Guideline

KW - Point-of-care ultrasound

KW - RAND

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International evidence-based recommendations for focused cardiac ultrasound

Abstract

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