Advertisement

Cardiac ultrasonography in obstetrics: a necessary skill for the present and future anesthesiologist

  • C.M. Ortner
    Correspondence
    Corresponding author. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA. (C.M. Ortner).
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
    Search for articles by this author
  • C. Padilla
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
    Search for articles by this author
  • B. Carvalho
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
    Search for articles by this author
Published:March 22, 2022DOI:https://doi.org/10.1016/j.ijoa.2022.103545
      In high-income countries, cardiovascular disease is the leading cause of maternal death,
      • Dawson A.J.
      • Krastev Y.
      • Parsonage W.A.
      • et al.
      Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis.
      and the incidence of postpartum hemorrhage continues to increase.
      • Bateman B.T.
      • Berman M.F.
      • Riley L.E.
      • Leffert L.R.
      The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries.
      Point-of-care ultrasonography (POCUS) has emerged as a valuable tool in the assessment of high-risk obstetric patients and women who experience bleeding or other complications during childbirth. The increasing burden in morbidity and obstetric critical illness over recent decades has led anesthesia experts to advocate for the use of POCUS on all high-acuity obstetric units.
      • Edwards Z.
      • Lucas D.N.
      • Gauntlett R.
      Is training in obstetric critical care adequate? An international comparison.
      With the advent of smaller and more affordable ultrasound machines
      • Baribeau Y.
      • Sharkey A.
      • Chaudhary O.
      • et al.
      Handheld point-of-care ultrasound probes: the new generation of POCUS.
      , the availability of ultrasound devices has increased, making POCUS no longer a skill confined to cardiologists and radiologists.
      • Patel M.D.
      Mapping the ultrasound landscape to define point-of-care ultrasound and diagnostic ultrasound: a proposal from the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound.
      Point-of-care ultrasonography has become an effective tool for guiding invasive procedures and supporting peri-operative decision making in all phases of clinical care and many settings.
      • Mahmood F.
      • Matyal R.
      • Skubas N.
      • et al.
      Perioperative ultrasound training in anesthesiology: a call to action.
      • Hadzic A.
      • Van Herreweghe I.
      • Lopez A.M.
      • Vandebergh V.
      Editorial: point-of-care ultrasound revolution in anesthesiology.
      Furthermore, focused cardiac ultrasound (FCU) has been proven effective to guide volume resuscitation, assess cardiac contractility, identify gross valvular abnormalities or pericardial effusion.
      • Spencer K.T.
      • Kimura B.J.
      • Korcarz C.E.
      • et al.
      Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.
      As a non-invasive diagnostic tool, POCUS offers a significant potential benefit in the obstetric environment where the clinical status of a previously healthy parturient can change rapidly and unexpectedly.
      • Dennis A.T.
      Transthoracic echocardiography in obstetric anaesthesia and obstetric critical illness.
      Focused cardiac ultrasound is also useful on a labor and delivery floor (for example to identify the underlying source of acute dyspnea and arterial hypotension at the bedside) where cardiology or radiology consultations are rarely available after hours.
      • Spencer K.T.
      • Kimura B.J.
      • Korcarz C.E.
      • et al.
      Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dawson A.J.
        • Krastev Y.
        • Parsonage W.A.
        • et al.
        Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis.
        BMJ Open. 2018; 8e022755https://doi.org/10.1136/bmjopen-2018-022755
        • Bateman B.T.
        • Berman M.F.
        • Riley L.E.
        • Leffert L.R.
        The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries.
        Anesth Analg. 2010; 110: 1368-1373https://doi.org/10.1213/ANE.0b013e3181d74898
        • Edwards Z.
        • Lucas D.N.
        • Gauntlett R.
        Is training in obstetric critical care adequate? An international comparison.
        Int J Obstet Anesth. 2019; 37: 96-105https://doi.org/10.1016/j.ijoa.2018.08.011
        • Baribeau Y.
        • Sharkey A.
        • Chaudhary O.
        • et al.
        Handheld point-of-care ultrasound probes: the new generation of POCUS.
        J Cardiothorac Vasc Anesth. 2020; 34: 3139-3145https://doi.org/10.1053/j.jvca.2020.07.004
        • Patel M.D.
        Mapping the ultrasound landscape to define point-of-care ultrasound and diagnostic ultrasound: a proposal from the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound.
        J Am Coll Radiol. 2021; 18: 11https://doi.org/10.1016/j.jacr.2020.09.013
        • Mahmood F.
        • Matyal R.
        • Skubas N.
        • et al.
        Perioperative ultrasound training in anesthesiology: a call to action.
        Anesth Analg. 2016; 122: 1794-1804https://doi.org/10.1213/ANE.0000000000001134
        • Hadzic A.
        • Van Herreweghe I.
        • Lopez A.M.
        • Vandebergh V.
        Editorial: point-of-care ultrasound revolution in anesthesiology.
        Curr Opin Anaesthesiol. 2021; 34: 607-608https://doi.org/10.1097/ACO.0000000000001053
        • Spencer K.T.
        • Kimura B.J.
        • Korcarz C.E.
        • et al.
        Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.
        J Am Soc Echocardiogr. 2013; 26: 567-581https://doi.org/10.1016/j.echo.2013.04.001
        • Dennis A.T.
        Transthoracic echocardiography in obstetric anaesthesia and obstetric critical illness.
        Int J Obstet Anesth. 2011; 20: 160-168https://doi.org/10.1016/j.ijoa.2010.11.007
        • Fagley R.E.
        • Haney M.F.
        • Beraud A.-S.
        • et al.
        Critical care basic ultrasound learning goals for American Anesthesiology Critical Care trainees: recommendations from an expert group.
        Anesth Analg. 2015; 120: 1041-1053https://doi.org/10.1213/ANE.0000000000000652
        • Jensen M.B.
        • Sloth E.
        • Larsen K.M.
        • Schmidt M.B.
        Transthoracic echocardiography for cardiopulmonary monitoring in intensive care.
        Euro J Anaesthesiol. 2004; 21: 700-707https://doi.org/10.1097/00003643-200409000-00006
        • Holm J.H.
        • Frederiksen C.A.
        • Juhl-Olsen P.
        • Sloth E.
        Perioperative use of focus assessed transthoracic echocardiography (FATE).
        Anesth Analg. 2012; 115: 1029-1032https://doi.org/10.1213/ANE.0b013e31826dd867
      1. Castro, G. Top 10 Health Technology Hazards for 2020, Available at: https://www.jointcommission.org/en/resources/news-and-multimedia/blogs/dateline-tjc/2020/01/top-10-health-technology-hazards-for-2020/.

        • Brohan J.
        • Taylor J.
        • West A.
        • Albert A.
        • Chau A.
        Developing an institutional focused cardiac ultrasound course for obstetric anesthesiologists.
        Int J Obstet Anesth. 2022; 49103233https://doi.org/10.1016/j.ijoa.2021.103233
        • Flower L.
        Training and accreditation pathways in critical care and perioperative echocardiography.
        J Cardiothorac Vasc Anesth. 2021; 13https://doi.org/10.1053/j.jvca.2020.07.046
        • Meineri M.
        • Arellano R.
        • Bryson G.
        • et al.
        Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres.
        Can J Anesth. 2021; 68: 376-386https://doi.org/10.1007/s12630-020-01867-2
        • Kirkpatrick J.N.
        • Grimm R.
        • Johri A.M.
        • et al.
        Recommendations for echocardiography laboratories participating in cardiac point of care cardiac ultrasound (POCUS) and critical care echocardiography training: report from the American Society of Echocardiography.
        J Am Soc Echocardiogr. 2020; 33: 409-422.e4https://doi.org/10.1016/j.echo.2020.01.008
        • Salerno A.
        • Tupchong K.
        • Verceles A.C.
        • McCurdy M.T.
        Point-of-care teleultrasound: a systematic review.
        Telemed J E Health. 2020; 26: 1314-1321https://doi.org/10.1089/tmj.2019.0177
        • Roy S.
        • Menapace W.
        • Oei S.
        • et al.
        Deep learning for classification and localization of COVID-19 markers in point-of-care lung ultrasound.
        IEEE Trans Med Imaging. 2020; 39: 2676-2687https://doi.org/10.1109/TMI.2020.2994459
        • Sjogren A.R.
        • Leo M.M.
        • Feldman J.
        • Gwin J.T.
        Image segmentation and machine learning for detection of abdominal free fluid in focused assessment with sonography for trauma examinations: a pilot study.
        J Ultrasound Med. 2016; 35: 2501-2509https://doi.org/10.7863/ultra.15.11017
        • Narang A.
        • Bae R.
        • Hong H.
        • et al.
        Utility of a deep-learning algorithm to guide novices to acquire echocardiograms for limited diagnostic use.
        JAMA Cardiol. 2021; 6: 624https://doi.org/10.1001/jamacardio.2021.0185
        • Padilla C.
        • Markwei M.
        • Easter S.R.
        • et al.
        Critical care in obstetrics: a strategy for addressing maternal mortality.
        Am J Obstet Gynecol. 2021; 224: 567-573https://doi.org/10.1016/j.ajog.2020.12.1208
      2. MBRRACE-UK_Maternal_Report_2021_-_FINAL_-_WEB_VERSION.pdf, https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2021/MBRRACE-UK_Maternal_Report_2021_-_FINAL_-_WEB_VERSION.pdf.