Cardiac Point-of-Care Ultrasound in Children
- 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.
- 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.
TRAINING, COMPETENCY ASSESSMENT AND QUALITY ASSURANCE
- Definitions of competency in pediatric cardiac POCUS are necessary for appropriate training and criteria for independent performance and supervising and teaching others. These definitions may vary among disciplines but will likely have many shared components.
- Regardless of specialty, core competencies for pediatric cardiac POCUS should include technical skill, interpretive skill, situational awareness, a core fund of knowledge with respect to physiology being evaluated (and differences between children and adults), ultrasound equipment, and the risks, benefits, and limitations of cardiac POCUS.
- There are no gold standards for competency assessment. Competency evaluation should use a combination of different methodologies for evaluating proficiency and mastery.
- Pediatric cardiac POCUS training should focus on assessment of competencies rather than completion of a course or number of studies.
- Competencies should be defined by subspeciality to reflect specific applications.
- Training in pediatric cardiac POCUS requires pediatric-specific training to address variation in patient size, scanning techniques, and potential physiologies.
- Learners should not perform cardiac POCUS in children without competent oversight by an experienced supervisor who is either physically present or able to review the images remotely at the time of the study.
- Infrastructure for ongoing training should include an identified cardiac POCUS lead and an image archiving system to facilitate education and ongoing quality assurance.
- Cardiac POCUS programs must include a plan for ongoing quality assurance. This should include regular review of archived cases as well as thoughtful evaluation of instructive cases in a manner that allows continuing education and improvement in performance. This will be particularly important as both the technology and the indications for cardiac POCUS continue to evolve.
Cardiac Point-of-Care Ultrasound in Children
January 23, 2023
Last Updated Month/Year
June 14, 2023
Country of Publication
Cardiac point-of-care ultrasound has the potential to improve patient care, but its application to children requires consideration of anatomic and physiologic differences from adult populations, and corresponding technical aspects of performance. This document is the product of an American Society of Echocardiography task force composed of representatives from pediatric cardiology, pediatric critical care medicine, pediatric emergency medicine, pediatric anesthesiology, and others, assembled to provide expert guidance. This diverse group aimed to identify common considerations across disciplines to guide evolution of indications, and to identify common requirements and infrastructure necessary for optimal performance, training, and quality assurance in the practice of cardiac point-of-care ultrasound in children. The recommendations presented are intended to facilitate collaboration among subspecialties and with pediatric echocardiography laboratories by identifying key considerations regarding (1) indications, (2) imaging recommendations, (3) training and competency assessment, and (4) quality assurance.
Male, Female, Adolescent, Child, Infant
Health Care Settings
Nurse, nurse practitioner, physician, physician assistant
Diagnosis, Assessment and screening, Management
D054849 - Cardiac Electrophysiology
children, pediatric, ultrasound, Ultrasound Examination, point of care
Lu JC, Riley A, Conlon T, Levine JC, Kwan C, Miller-Hance WC, Soni-Patel N, Slesnick T. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023 Jan 23:S0894-7317(22)00603-4. doi: 10.1016/j.echo.2022.11.010. Epub ahead of print. PMID: 36697294.