[Training and clinical use of focused echocardiography : Evaluation of the state of training and clinical application of perioperative focused echocardiography by anesthesiologists in Germany].

چکیده اصلی

BACKGROUND: Focused cardiac ultrasound (FOCUS) is a targeted point-of-care echocardiographic approach for rapid assessment of cardiac function and morphology. It is established in emergency and intensive care medicine and increasingly more relevant for making perioperative decisions. Data on its integration into perioperative workflows by anesthesiologists and on the role of training and supervision, remain limited. OBJECTIVE: This nationwide survey assessed FOCUS training, supervision and clinical application among anesthesiologists in Germany and examined how training and supervision were associated with self-reported confidence in performing FOCUS and the extent of its clinical use. MATERIAL AND METHODS: We conducted an anonymized digital cross-sectional survey among physician members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI). The standardized questionnaire comprised 21 items on professional background, echocardiographic training, supervised examinations, clinical integration of FOCUS and self-assessed skills. Training formats were grouped as no course, basic course, or basic plus advanced course. Supervision was recorded as the number of supervised FOCUS examinations after course attendance but the survey did not distinguish between bedside instruction, joint interpretation or image review. Complete datasets were analyzed using Pearson's χ2-test and Wilson 95% confidence intervals. RESULTS: Overall, 645 physicians participated and 469 completed the questionnaire. Senior physicians were overrepresented compared with the DGAI membership structure, whereas residents were underrepresented. More than 80% had completed at least one basic FOCUS course, yet more than 40% reported no supervised examinations before independently performing FOCUS in patients. Approximately 40% used FOCUS regularly, another 40% irregularly and 20% did not use it in practice. The FOCUS examination was used most often in emergency and intensive care situations, followed by intraoperative monitoring and preoperative evaluation. For elective preoperative assessment, cardiology was named most frequently, whereas before emergency surgery anesthesiologists were more often involved. Course participation was significantly associated with more frequent FOCUS use and supervised examinations showed an even stronger association with clinical use. Self-reported confidence in qualitative left ventricular function assessment and quantitative ejection fraction measurement increased with course level and supervision. Lack of qualification, insufficient supervision and time constraints were the main barriers. CONCLUSION: Despite high course participation and broad acceptance of FOCUS, the integration into perioperative practice remains limited. Courses alone appear insufficient for sustainable implementation. Supervision, continuous practice and structured longitudinal training pathways seem central to build confidence and support safe patient use. Beyond image interpretation, training should include correct device handling, suitable presets and exposure to normal and pathological findings. The use of FOCUS should be regarded as an adjunct to clinical assessment, not as a replacement for comprehensive cardiological echocardiography; it requires appropriate indications, technical proficiency and awareness of individual limitations. Interpretation is limited by the cross-sectional design, self-reported outcomes and selection bias towards a more experienced and FOCUS-affine subgroup.

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