Cardiovascular Phenotypes in 104 Hypotensive Perioperative Patients Using the Subcostal View (EASY)

Co-Author(s)

• BH

  Benjamin Hoenig, BS

  Medical student
  Albany Medical College, New York, United States

  Disclosure information not submitted.
• MB

  Michelle Burmistrova, BS

  Medical school applicant
  Albany Medical Center, United States

  Disclosure information not submitted.
• DK

  David King, BSN

  RN
  Albany Medical College, United States

  Disclosure information not submitted.
• RN

  Rhagav Narravula

  N/A
  Albany Medical College, United States

  Disclosure information not submitted.
• CP

  Cheshta Prasad

  N/A
  Albany Medical College, United States

  Disclosure information not submitted.
• AA

  Ashar Ata, MBBS, PhD

  Assistant Professor of Surgery
  Albany Medical College, United States

  Disclosure information not submitted.
• TK

  Tejas Kollu, BS

  Medical Student
  Albany Medical College, United States

  Disclosure information not submitted.
• PU

  Priya Uppal, BA, BS

  Medical Student
  Albany Medical College, United States

  Disclosure information not submitted.
• 

  Aliaksei Pustavoitau, MD, MHS,FCCM

  Associate Professor, ACCM, JHU, SOM
  Johns Hopkins University School of Medicine
  Baltimore, MD

  Disclosure information not submitted.

First Author(s)

• 

  Nibras Bughrara, MD, FASA,FCCM

  Associate professor of Anesthesiology and Surgery
  Albany Medical College
  Albany, NY

  Disclosure information not submitted.

  Slides

Title: Cardiovascular Phenotypes in 104 Hypotensive Perioperative Patients using the EASY Exam

Introduction: Focused Critical Care Echocardiography (FCCE) can aid in diagnosing undifferentiated shock. Organization of cardiovascular presentation on ultrasound into clusters allows for rapid selection of hemodynamic support. We implemented a standardized curriculum to use the Echocardiographic Assessment using Subxiphoid OnlY (EASY) exam to initially evaluate patients in shock in lieu of a more comprehensive FCCE exam. The EASY exam is based on pattern recognition of 7 proposed phenotypes grouped into 3 clusters based on similar management using a single subcostal four chamber view of the heart and IVC. Cluster 1 is normal to hyperdynamic ventricular function, cluster 2 is LV systolic dysfunction, and cluster 3 is isolated RV dysfunction. The goal of this study is to determine the prevalence of these phenotypes in patients with hypotension and to determine their outcome.

Methods: We reviewed EASY exams performed by trained anesthesia residents on perioperative patients in the POCU, PACU, ICU, and OR from August 2017 to June 2021. The first 104 patients who received a consult due to diagnosis of arterial hypotension (MAP < 65) of unknown etiology are included for analysis.

Results: In our cohort, 51% were male and mean age was 62.8. Prevalence for clusters 1-3 respectively was 66%, 27%, and 9%. 2 patients had pericardial tamponade. For clusters 1-3, respectively: mean ICU LOS was 8.2 days, 11.3 days, and 10.6 days. ICU mortality was 13.6%, 7.4%, and 55.6%. The most common 2 interventions in each cluster 1-3 respectively, were: IV fluid boluses given 24 times to 66 patients and phenylephrine (29 (43.9%) patients); norepinephrine (14 (51.2%) patients) and phenylephrine (11 (40.7%) patients); vasopressin and norepinephrine both given to 5 (55.6%) patients. Across all clusters, 36 patients had a diagnosis of sepsis. The EASY exam duration was 3.2 minutes and interpretable images were obtained in 91 patients. Imaging changed patient management in 64 cases.

Conclusion: The EASY exam is a novel approach to evaluating hemodynamic status using a subcostal only view of the heart. Trained physicians obtained interpretable images and assigned a phenotype which guided patient management in most of our cohort.