Cardiac POCUS is a subset of the general term cardiovascular ultrasound, but its distinction from echocardiography allows for more freedom in its use. The term gained global acceptance during the COVID-19 pandemic, as it reduced exposure to contagion for other personnel and facilities.
Cardiac POCUS is limited in scope, defined by the operator’s skill set and the indication particular to their specialty area. Still, it has inherent freedom from the requirements of a formal echocardiogram. This allows for more flexibility in resource settings, institutional requirements, and policy and the potential for expansion into other non-cardiac types of POCUS.
According to a study published in The American Journal of Medicine, in 1963, a cardiologist borrowed a neurologist’s ultrasound probe and placed it on a patient’s chest to determine if he could detect a pericardial effusion. This simple act began a fundamental aspect of cardiovascular diagnosis: cardiovascular ultrasound. As the field of cardiovascular ultrasound grew, so did the need for training, protocolization, quality control, and technological development. This resulted in the term “echocardiography,” encompassing all aspects of the field.
In response to the high-volume demand for cardiovascular ultrasound, the North American medical community separated the acquisition and interpretation skills to create an efficient delivery service: the Echocardiography Laboratory. Guidelines and standards were established to maintain quality, but these, along with the cost of ever-sophisticated machines, created barriers to entering the practice of echocardiography. Thus, cardiovascular ultrasound became the domain of specialists following a practice competency pathway.
However, the practice of cardiovascular ultrasound continues to evolve. Perhaps it is now seen as a ‘devolution’ from the structured echocardiography lab back to its origins and into the hands of non-conventional users. This has led to the emergence of the term “cardiac point-of-care ultrasound (POCUS),” which describes cardiovascular ultrasound at the bedside to answer immediate questions by medical providers from various training backgrounds.
Emergency medicine physicians were among the first specialists to perform limited bedside cardiac ultrasounds to identify life-threatening conditions such as cardiac tamponade or significant reduction in left ventricular function. Today, ultrasound education is widespread in North American emergency medicine training programs, and cardiac POCUS is recognized as a core competency for emergency medicine by various organizations, such as the Canadian Academy of Emergency Physicians, the American College of Emergency Physicians, and the American Academy of Emergency Medicine.
The scope of bedside cardiac assessment has expanded. It now includes a visual assessment of ejection fraction and pericardial effusion, as well as essential quantitative left ventricular function, right ventricular strain, and simple measures of diastolic dysfunction. Emergency medicine physicians typically complete at least 16 hours of didactic instruction (including hands-on experience) followed by 150 supervised scans across various core study types.
In the last 20 years, a sub-specialist class of emergency medicine physicians has emerged who have achieved additional competencies in ultrasound, including spectral Doppler modalities, regional wall motion assessment, and transesophageal qualifications. However, there needs to be recognized certification in ultrasound for emergency medicine physicians beyond the completion of residency training or documentation of completion of a practice-based training pathway.
