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Is brief echocardiographic training for noncardiology veterinarians useful? | VETgirl Veterinary Continuing Education Podcasts

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In this VETgirl online veterinary continuing education podcast, we review whether or not brief echocardiographic training is beneficial for noncardiology veterinarians. Will it help house officers or general practitioners in the ability to diagnose cardiac emergencies like pericardial effusion, congestive heart failure, cardiomyopathy and more?

As the availability of ultrasound is increasing in our emergency practices, many of us are using this tool to rapidly assess patients, looking for effusion in the abdomen or thorax, or for evidence of other thoracic abnormalities.1,2 Another potential use of the ultrasound machine is for evaluation of the heart, looking for evidence of cardiomyopathy, heart failure or volume status. While cardiologists are trained extensively to evaluate patients for these problems, the utility of ultrasound in assessing the heart by noncardiology veterinarians remains unknown.

So, Tse et al out of Tufts University wanted to evaluate this in a study called Evaluation of a training course in focused echocardiography for noncardiology house officers. This was published in J Vet Emerg Crit Care in 2013. The goal of this study was to determine if a brief (6 hour) echocardiography training course would be sufficient for noncardiology veterinarians (in this case, house officers) to evaluate patients in the emergency room for evidence of cardiovascular disease. So, house officers participated in a 3-hour didactic lecture and a 3-hour echo laboratory training session, with a written exam before training to judge baseline knowledge. There were 10 objectives for the training course, which included: (1) basic understanding of physics and the ultrasound machine, (2) correct identification of the heart’s anatomy and image orientation, (3) evaluation of cardiac chamber size or hypertrophy, (4) estimation of LV function, (5) identification of PCE, (6) identification of pleural effusion, (7) assessment of intravascular volume status, (8) identification of a thrombus or cardiac mass, (9) identification of cardiac disease, and (10) the ability to recognize a nondiagnostic study. After the training, a practical exam evaluating normal dogs and dogs with stable congenital or acquired cardiac disease was performed immediately with a written exam performed 5-18 days after training.

So, what’d this study find?
Evaluation of the practical and written exams revealed that 21 house officers (e.g., interns and noncardiology residents) completed the course and testing; 10 were from the emergency critical care service (9 residents, 1 intern). Mean written exam scores improved from 57 + 12% pre-training to 75 + 10% post-training. 86% of the participants improved on their written exam scores. The biggest areas of improvement on the written exam included identification of pleural and pericardial fluid, evaluation of contractile function and discrimination of normal and abnormal atrial size. Participants were not significantly better at identifying cardiac masses, volume status or poor quality studies following training. In the practical training and exam, 97% of participants could obtain fair to good right parasternal 2D short- or long-axis views of the heart. As for feedback, most participants felt that the laboratory training session was too short and they could have benefitted from additional training time.

So, what can we take away from this VETgirl podcast? Brief lecture and laboratory training in the “hows” and “how-tos” of basic echo can be helpful for identifying life-threatening cardiovascular diseases including pleural and pericardial effusion, increased atrial size, and decreased contractility. However, this amount of training was not adequate to allow house officers to accurately identify cardiac masses, volume status or poor quality studies (we all need more time in life, but in the meantime, we can refer to a cardiologist). That said, because most of the participants felt that additional hands-on training time would be helpful, one can hypothesize that additional training, if provided, might also increase the ability to identify other cardiac diseases, evaluate volume status, and so on.

Overall, we liked this study. Having been a lowly house officer before, it’s nice to know the potential benefits of brief echo training in noncardiology house officers can improve our quality of diagnostics and care in veterinary medicine. It would be interesting to apply this information in clinical patients and evaluate how frequently trained participants correctly identify underlying problems compared to non-trained veterinarians. This study suggests that brief echocardiographic training for veterinarians may be helpful in identifying life-threatening cardiovascular emergencies. This type of training might be helpful for us as emergency veterinarians in practice, and may be helpful in clinical decision making for patients in respiratory distress where only a limited exam is possible. After all, the more training, the more lives we can save!

References:
1. Boysen SR, Rozanski EA, Tidwell AS et al. Evaluation of a focused assessment with sonography for trauma protocol to detect free abdominal fluid in dogs involved in motor vehicle accidents. JAVMA 2004;225:1198-1204.
2. Lisciandro GR, Lagutchik MS, Mann KA et al. Evaluation of a thoracic focused assessment with sonography for trauma (TFAST) protocol to detect pneumothorax and concurrent thoracic injury in 145 traumatized dogs. JVECC 2008;18:258-269.
3. Tse YS, Rush JE, Cunningham SM, Bulmer BJ et al. Evaluation of a training course in focused echocardiography for noncardiology house officers. J Vet Emerg Crit Care 2013;23(3):268-273.

Abbreviations:
Echo: echocardiography
LV: left ventricle
PCE: pericardial effusion

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