Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock

A survey among members of the German Society of Medical Intensive Care and Emergency Medicine
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Abstract

Current international and national guidelines promote the use of emergency echocardiography in patients with cardiogenic shock. We assessed whether these recommendations are followed in clinical practice of infarct-related cardiogenic shock patients. For this purpose we conducted a web-based survey among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN); 40% of the DGIIN members completed the survey. Participants reported that in their department emergency echocardiography/ultrasound is performed on most patients in infarct-related cardiogenic shock presenting to the emergency department/chest pain unit or intensive care unit (58.6% versus 81.4%). Only 33% stated that on patients admitted directly to the catheterization laboratory emergency ultrasound/echocardiography is applied in their institution. Local availability of a standardized algorithm was lacking in the majority of departments (77.2%). A great proportion (38.3%) of participants stated that they personally had no formal training in emergency ultrasound. In order to meet the demands of the current guidelines, in addition to integration of ultrasound examinations into diagnostic algorithms, a structured training of all emergency and intensive care physicians is necessary.

Keywords

Cardiogenic shock Focused echocardiography Emergency ultrasound Education in ultrasound Acute coronary syndrome Critical care unit 

Notfallsonographie und Echokardiographie bei Patienten mit infarktbedingtem kardiogenem Schock

Eine Umfrage bei Mitgliedern der Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin

Zusammenfassung

Aktuelle nationale und internationale Leitlinien empfehlen den Einsatz der Notfallechokardiographie bei Patienten mit kardiogenem Schock. Ob diese Empfehlungen in der täglichen Praxis bei Patienten mit infarktbedingtem kardiogenem Schock (ikS) umgesetzt werden, ist unklar. Dies wurde in einer webbasierten Umfrage unter allen Mitgliedern der Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN) überprüft. Insgesamt nahmen 40 % der Mitglieder an der Umfrage teil. Die Mehrzahl der Befragten gab an, dass in ihrer Abteilung eine Notfallsono‑/Echokardiographie bei Patienten im ikS durchgeführt wird, sobald diese in der Notaufnahme bzw. Chest Pain Unit oder auf der Intensivstation aufgenommen werden (58,6 % versus 81,4 %). Wird ein Patient direkt über das Herzkatheterlabor aufgenommen, berichteten nur 33 % der Befragten, dass in ihrer Abteilung eine Notfallsono‑/Echokardiographie vor der Intervention durchgeführt wird. Ein standardisierter Algorithmus zur Integration des Ultraschalls fehlt in den meisten Abteilungen (77,2 %). Eine große Anzahl an Teilnehmern berichtet, dass sie persönlich keine Ausbildung im Bereich der Sonographie genossen haben. Um den Forderungen der aktuellen Leitlinien gerecht zu werden, ist neben der Integration von Ultraschalluntersuchungen in die diagnostischen Algorithmen eine strukturierte Ausbildung aller Notfall- und Intensivmediziner notwendig.

Schlüsselwörter

Kardiogener Schock Fokussierte Echokardiographie Notfallsonographie Ultraschallausbildung Akutes Koronarsyndrom Intensivstation 

Notes

Acknowledgements

We would like to thank all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN).

Compliance with ethical guidelines

Conflict of interest

G. Michels, D. Hempel, R. Pfister and U. Janssens declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent was obtained from all persons included in the survey.

Supplementary material

63_2018_431_MOESM1_ESM.pdf (196 kb)
Questionnaire of the web-based survey—Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • G. Michels
    • 1
  • D. Hempel
    • 2
  • R. Pfister
    • 1
  • U. Janssens
    • 3
  1. 1.Department III of Internal MedicineUniversity Hospital of CologneCologneGermany
  2. 2.Department of Emergency MedicineUniversity Hospital JenaJenaGermany
  3. 3.Department of CardiologySt Antonius HospitalEschweilerGermany

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