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Special Article| Volume 36, ISSUE 1, P22-29, January 2022

Diagnostic Point-of-Care Ultrasound: Recommendations From an Expert Panel

Published:April 16, 2021DOI:https://doi.org/10.1053/j.jvca.2021.04.016
      Diagnostic point-of-care ultrasound (PoCUS) has emerged as a powerful tool to help anesthesiologists guide patient care in both the perioperative setting and the subspecialty arenas. Although anesthesiologists can turn to guideline statements pertaining to other aspects of ultrasound use, to date there remains little in the way of published guidance regarding diagnostic PoCUS. To this end, in 2018, the American Society of Anesthesiologists chartered an ad hoc committee consisting of 23 American Society of Anesthesiologists members to provide recommendations on this topic. The ad hoc committee convened and developed a committee work product. This work product was updated in 2021 by an expert panel of the ad hoc committee to produce the document presented herein. The document, which represents the consensus opinion of a group of practicing anesthesiologists with established expertise in diagnostic ultrasound, addresses the following issues: (1) affirms the practice of diagnostic PoCUS by adequately trained anesthesiologists, (2) identifies the scope of practice of diagnostic PoCUS relevant to anesthesiologists, (3) suggests the minimum level of training needed to achieve competence, (4) provides recommendations for how diagnostic PoCUS can be used safely and ethically, and (5) provides broad guidance about diagnostic ultrasound billing.

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      References

        • American College of Emergency Physicians
        Emergency ultrasound guidelines.
        Ann Emerg Med. 2009; 53: 550-570
        • Mayo PH
        • Beaulieu Y
        • Doelken P
        • et al.
        American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography.
        Chest. 2009; 135: 1050-1060
      1. Pustavoitau A, Blaivas M, Brown S, et al (Ultrasound Certification Task Force on behalf of the Society of Critical Care Medicine). Recommendations for achieving and maintaining competence and credentialing in critical care ultrasound with focused cardiac ultrasound and advanced critical care echocardiography. Available at: https://journals.lww.com/ccmjournal/Documents/Critical%20Care%20Ultrasound.pdf. Accessed March 21, 2021.

        • Via G
        • Hussain A
        • Wells M
        • et al.
        International evidence-based recommendations for focused cardiac ultrasound.
        J Am Soc Echocardiogr. 2014; 27 (683.e681-3.e633)
      2. Expert Round Table on Echocardiography in ICU. International consensus statement on training standards for advanced critical care echocardiography.
        Intensive Care Med. 2014; 40: 654-666
      3. Ultrasound guidelines: Emergency, point-of-care and clinical ultrasound guidelines in Medicine.
        Ann Emerg Med. 2017; 69: e27-e54
        • Levitov A
        • Frankel HL
        • Blaivas M
        • et al.
        Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part II: Cardiac ultrasonography.
        Crit Care Med. 2016; 44: 1206-1227
        • Frankel HL
        • Kirkpatrick AW
        • Elbarbary M
        • et al.
        Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part I: General ultrasonography.
        Crit Care Med. 2015; 43: 2479-2502
        • American Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography
        Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography.
        Anesthesiology. 2010; 112: 1084-1096
      4. Practice guidelines for central venous access 2020: An updated report by the American Society of Anesthesiologists Task Force on Central Venous Access.
        Anesthesiology. 2020; 132: 8-43
        • American College of Emergency Physicians
        Emergency ultrasound imaging criteria compendium. American College of Emergency Physicians.
        Ann Emerg Med. 2006; 48: 487-510
        • Conlin F
        • Roy Connelly N
        • Raghunathan K
        • et al.
        Focused transthoracic cardiac ultrasound: A survey of training practices.
        J Cardiothorac Vasc Anesth. 2016; 30: 102-106
        • Dominguez JE
        • Habib AS
        • Bronshteyn YS.
        Assessment of point-of-care ultrasound training for obstetric anesthesiology fellows in the USA and Canada: A survey of program directors.
        Int J Obstet Anesth. 2020; 41: 126-127
      5. American Medical Association. Privileging for ultrasound imaging H-230.960. Available at: https://policysearch.ama-assn.org/policyfinder/detail/Ultrasoundimaging?uri=%2FAMADoc%2FHOD.xml-0-1591.xml. Accessed March 14, 2021.

      6. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in anesthesiology. Available at: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/040_Anesthesiology_2020.pdf?ver=2020-06-18-132902-423. Accessed March 14, 2021.

      7. American Board of Anesthesiology. Primary certification in anesthesiology. Available at: https://theaba.org/pdfs/Initial_Certification_Content_Outline.pdf. Accessed March 14, 2021.

        • Zimmerman JM
        • Coker BJ.
        The nuts and bolts of performing focused cardiovascular ultrasound (FoCUS).
        Anesth Analg. 2017; 124: 753-760
        • Lenk T
        • Whittle J
        • Miller TE
        • et al.
        Focused cardiac ultrasound in preoperative assessment: The perioperative provider's new stethoscope?.
        Perioper Med (Lond). 2019; 8: 16
        • Perlas A
        • Chan VW
        • Lupu CM
        • et al.
        Ultrasound assessment of gastric content and volume.
        Anesthesiology. 2009; 111: 82-89
        • Ramsingh D
        • Bronshteyn YS
        • Haskins S
        • et al.
        Perioperative point-of-care ultrasound: From concept to application.
        Anesthesiology. 2020; 132: 908-916
        • Ramsingh D
        • Rinehart J
        • Kain Z
        • et al.
        Impact assessment of perioperative point-of-care ultrasound training on anesthesiology residents.
        Anesthesiology. 2015; 123: 670-682
        • Volpicelli G
        • Elbarbary M
        • Blaivas M
        • et al.
        International evidence-based recommendations for point-of-care lung ultrasound.
        Intensive Care Med. 2012; 38: 577-591
        • Ostrom E
        • Joseph A.
        The use of musculoskeletal ultrasound for the diagnosis of groin and hip Pain in athletes.
        Curr Sport Med Rep. 2016; 15: 86-90
        • Subramaniam S
        • Bober J
        • Chao J
        • et al.
        Point-of-care ultrasound for diagnosis of abscess in skin and soft tissue infections.
        Acad Emerg Med. 2016; 23: 1298-1306
        • Schmidt BE
        • Lam AM.
        “Wave” of the future in neuroanesthesiology too!.
        Anesth Analg. 2017; 124: 371
        • Nazerian P
        • Volpicelli G
        • Gigli C
        • et al.
        Diagnostic performance of Wells score combined with point-of-care and venous ultrasound in suspected pulmonary embolism.
        Acad Emerg Med. 2017; 24: 270-280
        • Blehar DJ
        • Barton B
        • Gaspari RJ
        Learning curves in emergency ultrasound education.
        Acad Emerg Med. 2015; 22: 574-582
        • Frederiksen CA
        • Juhl-Olsen P
        • Andersen NH
        • et al.
        Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard.
        Scand j trauma resusc emerg med. 2013; 21: 87
        • Zimmerman J
        A Recipe for Success in Echocardiography Training: The University of Utah Experience.
        J Cardiothorac Vasc Anesth. 2018; 32: 2607-2613
        • Arzola C
        • Carvalho JC
        • Cubillos J
        • et al.
        Anesthesiologists' learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study.
        Can J Anesth. 2013; 60: 771-779
        • Arbelot C
        • Dexheimer Neto FL
        • et al.
        Lung Ultrasound in Emergency and Critically Ill Patients: Number of Supervised Exams to Reach Basic Competence.
        Anesthesiology. 2020; (PMID:31917702)
      8. American Society of Anesthesiologists. Diagnostic POCUS certificate program. Available at: www.asahq.org/POCUS. Accessed March 21, 2021.

        • Nelson TR
        • Fowlkes JB
        • Abramowicz JS
        • et al.
        Ultrasound biosafety considerations for the practicing sonographer and sonologist.
        J Ultrasound Med. 2009; 28: 139-150
      9. U.S. Department of Health and Human Services. 2017 Medicare fee-for-service supplemental improper payment data. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/Downloads/2017-Medicare-FFS-Improper-Payment.pdf. Accessed March 21, 2021.

        • Spencer KT
        • Kimura BJ
        • Korcarz CE
        • et al.
        Focused cardiac ultrasound: Recommendations from the American Society of Echocardiography.
        J Am Soc Echocardiogr. 2013; 26: 567-581
        • Labovitz AJ
        • Noble VE
        • Bierig M
        • et al.
        Focused cardiac ultrasound in the emergent setting: A consensus statement of the American Society of Echocardiography and American College of Emergency Physicians.
        J Am Soc Echocardiogr. 2010; 23: 1225-1230
        • Haskins SC
        • Bronshteyn Y
        • Perlas A
        • et al.
        American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part I: Clinical indications [e-pub ahead of print].
        Reg Anesth Pain Med. 2021; https://doi.org/10.1136/rapm-2021-102560
        • Haskins SC
        • Bronshteyn Y
        • Perlas A
        • et al.
        American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part II: Recommendations [e-pub ahead of print].
        Reg Anesth Pain Med. 2021; https://doi.org/10.1136/rapm-2021-102561

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