(770) Point-of-Care Ultrasound in the Pediatric Cardiac ICU: Survey of Use, Needs, and Future Directions

Monday, January 22, 2024

11:30 AM – 12:30 PM MT

Location: Connections Central - RST 05

First Author(s)

BK

Benjamin W. Kozyak, MD, (he/him/his)

Attending Physician, Cardiac Critical Care Medicine
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Co-Author(s)

JP

Jamie S. Penk, MD

Assistant Professor of Pediatrics (Cardiology)
Lurie Children's Hospital, United States
SB

Shazia Bhombal, MD

Associate Professor of Pediatrics
Emory University School of Medicine, United States
DW

David K. Werho, MD

Associate Clinical Professor, Pediatrics
University of California - San Diego, Rady Children's Hospital, United States
Gabriella I. Centers, MD

Assistant Professor of Clinical Pediatrics
Indiana University School of Medicine, United States
JD

John W. Diddle, MD

Director, Quality Outcomes in Critical Care; Asst Professor of Pediatrics
Childrens National Health Systems, George Washington Univ School of Medicine, United States
Saul Flores, MD, FCCM

Associate Professor
Texas Children's Hospital
Houston, Texas
AF

Alejandro Floh, MD

Assistant Professor, Department of Paediatrics
The Hospital for Sick Children, University of Toronto School of Medicine, United States
AH

Anyir Hsieh, MD, MPH

Assistant Professor of Clinical Pediatrics
Childrens Hopital Los Angeles, Keck School of Medicine of USC, United States
MM

Mjaye Mazwi, MD, MBChB

Associate Professor, Dept of Paediatrics
The Hospital for Sick Children (SickKids), Univ. of Toronto, United States
MM

Michael J. Martinez, MD

Clinical Assistant Professor
Department of Pediatrics at NYU Grossman School of Medicine, United States
JM

Jaclyn Mckinstry, MD

Assistant Professor
Department of Pediatrics at NYU Grossman School of Medicine, United States
MM

Marcos Mills, MD

Assistant Professor of Pediatrics
Emory University School of Medicine, United States
MP

Meghna Patel, MD

Clinical Assistant Professor
Stanford University Medical Center, United States
Michelle M. Ramirez, MD

Assistant Professor
Department of Pediatrics at NYU Grossman School of Medicine
Brooklyn, NY, United States
YS

Yogen Singh, MBBS, MD, MA, DCH, FRCPCH

Professor of Pediatrics
Loma Linda University, United States
RW

Renee Willett, MD

Clinical Associate of Anesthesiology and Critical Care
The Children's Hospital of Philadelphia, Univ. of Pennsylvania School of Medicine, United States
BL

Boran Li, MD

Assistant Professor of Pediatrics
Icahn School of Medicine at Mount Sinai, United States
Niranjan Vijayakumar, MD (he/him/his)

Instructor in Pediatrics
Boston Children's Hospital, Harvard Medical School
Boston, Massachusetts, United States
ES

Erik Su, MD

Assistant Professor, Adult Congenital Heart Disease ICU
Baylor College of Medicine Texas Children's Hospital
Houston, Texas

Introduction: Use of point-of-care ultrasound (POCUS) has expanded rapidly across Critical Care Medicine. It has made procedures safer, while informing and expediting the evaluation of patients with cardiorespiratory failure. Pediatric Cardiac Critical Care is unique in the complexity of its patients and multidisciplinary approach. Despite a large number of cardiologist-intensivists, the field lacks consensus on the appropriate use of POCUS. We endeavored to understand current usage patterns, perspective on appropriate scope, perceived needs, and barriers to POCUS within Pediatric Cardiac ICUs.

Methods: A 33-question survey was developed, vetted by the Scientific Committees of the Pediatric Cardiac Intensive Care Society (PCICS) and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). It was distributed by PCICS, and the results analyzed.

Results: Ninety-one CICU providers (75 MDs, 16 NPs) completed the survey, representing 55 institutions and 63% of PC4 centers. Most were dedicated CICUs in the U.S.; 7 were international. 63% were in their first 10 years of practice, 36% in their first 5.

Nearly all utilized POCUS for vascular access. US was also used for thoracentesis (76%), paracentesis (58%), and cardiac assessments (68%), including evaluation of cardiac arrest (47%). Chest tubes were most often placed by cardiac surgeons in 75% of CICUs represented, and by intensivists in 25%; intensivists were more likely to use US (85% vs 36%).

Use of POCUS for all of the above applications was felt by most respondents to be both feasible and relevant. Ninety-five percent (95%) and 70% of respondents believed that CICU MDs and NPs should use POCUS for limited cardiac assessments, respectively. Barriers include lack of time (54%), education (49%), quality assurance (44%), credentialing (41%), and established workflows (40%). Interestingly, 45% of respondents also cited limitations imposed by peers.

Conclusions: Procedural and diagnostic POCUS, including targeted cardiac assessments, are highly relevant to pediatric CICU practice, and felt by providers to be both feasible and in-scope for MDs and NPs alike. Effort should be focused on openly addressing both infrastructural and cultural barriers, in order to ensure that bedside ultrasound is utilized rigorously and safely in our vulnerable CICU patients.