Report Advocates Ultrasound Use in Fields Outside of Cardiology

Investigators recently reported that there is increasing evidence regarding the utility of ultrasound in areas outside its traditional field of cardiology, with increasing use reported in general hospital rooms, clinics, and even prehospital settings.

The study’s findings were published in the January 2014 issue of Global Heart, the journal of the World Heart Federation, and authored by Assoc. Prof. Bret Nelson and Dr. Amy Sanghvi, from Mount Sinai School of Medicine (New York, NY, USA). “The pervasive use of focused ultrasound is perhaps most evident in the advent of ultrasound training in undergraduate medical curricula,” reported the authors. They refer to a 2011 review article that emphasized the rising use of point-of-care ultrasound by clinicians in over 20 specialties. “Increased training by clinicians across many specialties, coupled with technology improvements yielding lower cost and better quality studies, have contributed to this trend,” they added.

In emergency medicine care, as well as providing faster and accurate diagnoses in most patients compared with physical examinations by themselves, the investigators reported that the prognostic value of emergency physician-performed cardiac ultrasound has been validated. Several studies have demonstrated that no cardiac arrest patients without cardiac activity evident on ultrasound survived resuscitation.

Many studies have addressed the use of point-of-care ultrasound in general hospital wards and clinics. A clinic-based study of first-year medical students instructed in the use of ultrasound demonstrated they were able to identify pathology in 75% of patients with known cardiac disease, where board-certified cardiologists using stethoscopes could detect only 49%. Pocket-sized ultrasound devices were used by general practitioners (GPs) in Norway to assess left ventricular function in patients with suspected heart failure. In that country, 92 patients were evaluated by GPs as well as cardiologists, and the measurements obtained with ultrasound by GPs correlated well with those obtained by cardiologists.

Outside the clinic, ultrasound has also been proving its worth. In setting where ambulances are staffed by physicians, the researchers evaluated patients in cardiac arrest as well as those receiving peri-arrest care. The FEEL (Focused Echocardiography Evaluation in Life Support) study demonstrated that cardiac ultrasound changed management in 89% of the cardiac arrest patients and 66% of peri-arrest patients. The opportunity also exists for ambulances to transmit ultrasound images to the in-hospital emergency teams awaiting the arrival of the incoming patient, with potentially life-saving implications.

Moreover, the authors refer to wide-ranging examples of ultrasound being included in the latest medical education curricula in the United States and Germany. Many countries worldwide are increasingly seeing the benefits of educating their medical students in this important technique.

The authors concluded, “Dramatic technology advancements continue to change the face of medicine. In the first several decades of medical ultrasound use, machine cost, size, and significant training requirements meant the technology was used mainly by radiology, obstetrics, and cardiology departments. As the machines progressed into less expensive, portable devices and other specialties demonstrated the value of qualitative point-of-care assessments, there has been an explosion of specialties using ultrasound. The need for comprehensive sonographic assessments by specialist consultants is unlikely to wane with the advent of point-of-care ultrasound. As our healthcare system becomes increasingly interested in cost-effective and evidence-based care, we are likely to see clinician-performed focused examinations complemented by comprehensive specialist studies with clear clinical indications.”

Prof. Jagat Narula, editor-in-chief of Global Heart, added, “As the ultrasound training becomes a universal part of training in medical schools, hand-held devices would be carried by physicians, just as stethoscopes are today.”

Related Links:
Mount Sinai School of Medicine