• Luke Flower, Alicia Waite, Adam Boulton, Marcus Peck, Waqas Akhtar, Andrew J Boyle, Sandeep Gudibande, Thomas E Ingram, Brian Johnston, Sarah Marsh, Ashley Miller, Amy Nash, Olusegun Olusanya, Prashant Parulekar, Daniel Wagstaff, Jonathan Wilkinson, Alastair G Proudfoot, and NEAT ECHO Collaborators.
• Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK. luke.flower@doctors.org.uk.
• Intensive Care Med. 2024 Oct 1; 50 (10): 166816801668-1680.

PurposeEchocardiography is recommended as a first-line tool in the assessment of patients with shock. The current provision of echocardiography in critical care is poorly defined. The aims of this work were to evaluate the utilisation of echocardiography in patients presenting to critical care with shock, its impact on decision making, and adherence to governance guidelines.MethodsWe conducted a prospective, multi-centre, observational study in 178 critical care units across the United Kingdom (UK) and Crown Dependencies, led by the UK's Trainee Research in Intensive Care Network. Consecutive adult patients (≥ 18 years) admitted with shock were followed up for 72 h to ascertain whether they received an echocardiogram, the nature of any scan performed, and its effect on critical treatment decision making.Results1015 patients with shock were included. An echocardiogram was performed on 545 (54%) patients within 72 h and 436 (43%) within 24 h 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 or cardiogenic shock had their management altered numerically more often by echocardiography (n = 15 [75%] and n = 100 [58%] respectively). Twenty-five percent of echocardiograms performed adhered to current national governance and image storage guidance.ConclusionUse 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.© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.

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