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

Research output: Contribution to journalArticlepeer-review

392 Scopus citations


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 languageEnglish (US)
Pages (from-to)683.e1-683.e33
JournalJournal of the American Society of Echocardiography
Issue number7
StatePublished - Jul 2014

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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.


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


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