Nibras Bughrara, MD, FASA,FCCM
Associate professor of Anesthesiology and Surgery
Albany Medical College
Albany, NY
Disclosure information not submitted.
Kate Kernan, MD
Assistant Professor
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, United States
Disclosure information not submitted.
.jpg "Aliaksei Pustavoitau, MD, MHS,FCCM photo")
Aliaksei Pustavoitau, MD, MHS,FCCM
Associate Professor, ACCM, JHU, SOM
Johns Hopkins University School of Medicine
Baltimore, MD
Disclosure information not submitted.
Qainat Shah, MS4
Medical Student
Albany Medical Center
Albany, New York, United States
Disclosure information not submitted.
Title:Preintubation Echocardiographic Assessment Using Subcostal-Only View (EASy) Exam: A Case Series
INTRODUCTION/HYPOTHESIS: Induction and intubation can cause cardiovascular instability, hypoxemia, and cardiac arrest. The EASy exam is a subcostal four-chamber view (SC4C), followed by inferior vena cava (IVC) and upper lung field views performed in quick succession. The goal of this study was to evaluate the impact of single-day EASy training on management prior to induction and intubation.
Methods: EASy training consists of a combination of a web-based curriculum, live lecture, and 10 exams performed under direct supervision. The EASy protocol was performed before emergency intubation on five critically ill patients. In this case series, we describe findings and management based on the EASy phenotypes (pattern recognition).
Results: Five resident-obtained EASy studies were performed in the ICU for emergency intubation. Two patients had COVID-19. Three had hyperdynamic ventricles with a small left ventricular (LV) cavity size with a < 1.5cm fully collapsible IVC consistent with hypovolemia (two of which had thickened LV walls indicating likely diastolic dysfunction). These three patients received a 10mL/kg IV fluid bolus to counteract vasodilation and decreased venous return, and were started on phenylephrine. The fourth had normal contractility and diastolic cavity size with a normal-sized collapsible IVC. The fifth patient had biventricular dilation with reduced systolic function and a plethoric IVC. For this patient, no fluid bolus was given, and a vasopressor with inotropic properties (norepinephrine) was started. Etomidate was used for induction and intubation. The mean time for completion was 3 minutes (range 2 to 4 minutes). Three studies were deemed "good" quality and two were deemed "adequate" by an attending physician proficient in critical care ultrasound. Vitals were monitored for 15 minutes post-intubation, and all patients maintained hemodynamic stability with MAP ≥ 65mmHg.
Conclusions: EASy exam aids clinical decision-making in the pre-induction and intubation period, where interventions can have deleterious and even fatal consequences.