Journal of the American Society of Echocardiography
Special ArticleInternational Evidence-Based Recommendations for Focused Cardiac Ultrasound
Section snippets
Recommendation-Building Methodology
The evidence-based statements and recommendations presented in this document were developed using a rigorous methodologic regimen, previously described, starting with the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) method.36 This approach entails: (1) a preliminary determination of the quality of available evidence and (2) the subsequent development of the recommendations. All articles concerning the conference object were ranked into three levels of quality
Literature Search Results
The complete literature search was then screened for clearly nonpertinent findings; the final bibliography was consistent with the definition of FoCUS and agreed on by the panel. A total of 293 articles (as of June 2012) were retrieved by the two search tracks. Two additional searches were performed over a 15-month period (June 2012 to September 2013), reaching the final number of 382 articles (Appendix 3 in the ESM). These were individually appraised on the basis of established methodologic
Knowledge Gaps and Future Research Directions
The lack of adequately powered outcome-based studies to prove benefit of use of FoCUS in the various specific clinical settings is certainly the major knowledge gap. Exhaustive data on the cost-effectiveness of FoCUS use should also be acquired, especially in the critical care scenario. Validation of integrated clinical ultrasound protocols for FoCUS-driven patient management should be studied. Impact evaluation of FoCUS-based early goal-directed management of septic shock, cardiogenic shock,
Conclusions
The primary impetus for the development and promulgation of FoCUS is to increase access to this important diagnostic tool.
Multiple converging sources of evidence support the fact that FoCUS is a diagnostic tool; its use determines diagnoses contemporaneously with treatment and management and mitigates diagnostic uncertainty. Like all diagnostics, the expectation of FoCUS is to facilitate patient care and, thereby, improve outcomes. FoCUS requires archiving, reporting, and, where relevant,
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Dr Bowra is a member of the Medical Advisory Board of Signostics Pty Ltd. Dr Neskovic is an advisor to Medtronic and AstraZeneca and has received consultative honoraria from these companies. Dr Neskovic has received honoraria from Merck and research funds from GE Healthcare. Dr Sloth is an uncompensated member of the Medical Advisory Board of GE Vscan and an uncompensated lecturer for Philips. All other members declared no conflict of interest. No direct sponsorship of any kind has been provided by any commercial or industrial source. No honoraria have been given to any of the panel members.
Promoted by the World Interactive Network Focused on Critical UltraSound (WINFOCUS). Endorsed by the American Society of Echocardiography (ASE), the European Association of Cardiovascular Imaging (EACVI), the British Society of Echocardiography (BSE), the Indian Society of Critical Care Medicine (ISCCM), the Chinese Society of Critical Care Medicine (CSCCM), the International Pan-Arab Critical Care Medicine Society (IPACCS), Associação do Medicina Intensiva Brasileira (AMIB), the European Society of Emergency Medicine (EuSEM), the American College of Emergency Physicians (ACEP), the Australasian College for Emergency Medicine (ACEM), the Asian Society for Emergency Medicine (ASEM), the Emergency Medicine Society of South Africa (EMSSA), the Society for Ultrasound in Medical Education (SUSME), the Australian Society for Ultrasound in Medicine (ASUM), the Saudi Heart Association (SHA), and the Pediatricians with Expertise in Cardiology Special Interest Group (PECSIG).