The use of echocardiography in the management of shock in critical care: a prospective, multi-centre, observational study

Abstract

Purpose Echocardiography is an essential tool in the assessment of patients with shock. The current provision of echocardiography in critical care is poorly defined. We sought to evaluate the utilisation of echocardiography in patients presenting to critical care with undifferentiated shock and its impact on decision making. Methods We conducted a prospective, multi-centre, observational study in 178 critical care units across the United Kingdom and Crown Dependencies. The study was led by the UK’s Trainee Research in Intensive Care Network. Consecutive adult patients (≥ 18 years) admitted with shock were followed up for 72 hours to ascertain whether they received an echocardiogram, the nature of any scan performed, and its effect on critical treatment decision making. Results 1015 patients with undifferentiated shock were included. An echocardiogram was performed on 545 (54%) patients within 72 hours and 463 (43%) within 24 hours of admission. Most scans were performed by the critical care team (n = 314, 58%). Echocardiography was reported to either reduce diagnostic uncertainty or change management in 291 (54%) cases. Patients with obstructive, cardiogenic, or mixed shock had their management altered numerically more often by echocardiography (n = 15 [71%], n = 100 [58%] and n = 67 [58%]). 24% of echocardiograms performed adhered to current national information governance and image storage guidance. Conclusion Use of echocardiography in the assessment of patients with shock remains heterogenous. When echocardiography is used, it improves diagnostic certainty or changes management in most patients. Future research should explore barriers to increasing use of echocardiography in assessing patients presenting with shock.