Cardiac Point-of-Care Ultrasound in Children

Publication Date: January 23, 2023
Last Updated: January 31, 2023

INDICATIONS

  • Cardiac POCUS is a problem-oriented, physiology-based imaging tool performed by noncardiology clinicians to complement other clinical data elements and enhance patient management.
  • Cardiac POCUS clinical applications should be governed by three requirements: pathophysiology amenable to ultrasound interrogation, frequently encountered clinical scenario and/or requiring urgent intervention, and sufficient availability of effective training.
  • Cardiac POCUS can be used to evaluate physiologic causes and effects of hypotension, shock, and circulatory arrest, including preload and volume responsiveness, qualitative LV systolic function, presence of pericardial effusion, and qualitative assessment of RV size and systolic pressure.
  • Cardiac POCUS is not appropriate to evaluate signs or symptoms that suggest CHD (e.g., cyanosis, heart murmurs) and should not be used to rule in or rule out CHD. Clinical suspicion of CHD should be referred for pediatric cardiology consultation and is beyond the scope of cardiac POCUS.
  • Strong caution is recommended when using cardiac POCUS in patients with known CHD. Cardiac POCUS may have a role in immediate stabilization of such patients but should be followed by support and evaluation by pediatric cardiologists.
  • Mild systolic dysfunction in children can be an important clinical finding but is difficult to exclude by cardiac POCUS; standard echocardiography is recommended if there is uncertainty by cardiac POCUS or if there are clinical concerns for cardiac dysfunction or injury.
  • Local echocardiography laboratories should have an opportunity to be involved in the adoption and implementation of cardiac POCUS indications appropriate for their local institutions.
  • Cardiac POCUS is appropriate in pediatric patients presenting with hemodynamic instability or acute respiratory distress when CHD is not suspected. Its role in nonemergent situations remains to be defined.

IMAGING RECOMMENDATIONS

  • Ultrasound equipment for cardiac POCUS in pediatrics should be selected with a range of frequencies for the range of depths in this population.
  • An ultrasound probe for a given pediatric patient should be chosen with consideration of frequency and footprint size.
  • Cardiac POCUS assessment should be focused on the clinical scenario, to act upon abnormal findings identified. However, a normal cardiac POCUS study is not sufficient to rule out significant cardiac disease.
  • To facilitate multidisciplinary collaboration, cardiac POCUS should have consistent orientation of cardiac structures in displayed and stored images across subspecialties within an institution.
  • POCUS images should be obtained and stored with leftward cardiac structures on the right side of the screen, except for the parasternal long-axis view.
  • For apical and subcostal long-axis images, either apex-up or apex-down orientation may be used, according to training and local practice.
  • Images from cardiac POCUS studies should be stored and linked to the patient medical record whenever clinically feasible.
  • POCUS findings should be reported in the medical record and described qualitatively or semiquantitatively.

Overview

Title

Cardiac Point-of-Care Ultrasound in Children

Authoring Organization