British Society of Echocardiography Departmental Accreditation Standards 2019 with input from the Intensive Care Society

This article sets out a summary of standards for departmental accreditation set by the British Society of Echocardiography (BSE) Departmental Accreditation Committee. Full accreditation standards are available at www.bsecho.org. The BSE were the first national organisation to establish a quality standards framework for departments that support the practice of individual echocardiographers. This is an updated version which recognises that, not only should all echocardiographers be individually accredited as competent to practice, but that departments also need to be well organised and have the facilities, equipment and processes to ensure the services they deliver are of an appropriate clinical standard. In combination with individual accreditation, departmental accreditation lays down standards to help ensure safe and effective patient care. These standards supersede the 2012 BSE Departmental Accreditation Standards. Standards are set to cover all potential areas of practice, including transthoracic (level 2) echocardiography, transoesophageal echocardiography, stress echocardiography, training, and emergency (level 1) echocardiography. The emergency echocardiography standard is a new addition to departmental accreditation and has been developed with input from the Intensive Care Society.

Emergency echocardiography

Reaching a diagnosis in unstable patients presenting with symptoms and signs suggestive of acute cardiovascular pathology usually requires a focused patient’s history, physical examination, 12-lead electrocardiogram, and additional laboratory tests and imaging studies. It seems unarguable that echocardiography fits better than any currently available imaging technique for use in challenging emergency situations: it is low-cost, non-invasive, widely accessible, portable, and accurately describes cardiac morphology and function. It can be rapidly performed virtually everywhere while the instantly available results of the examination allow prompt initiation of appropriate therapy. These facts may explain the evolving use of echocardiography by non-cardiologists or cardiologists without specific expertise, and the increasing trend of using focus cardiac ultrasound (FoCUS) as a bedside, point-of-care diagnostic test during initial evaluation in cardiac emergencies.

The use of daptomycin for the treatment of infectious endocarditis: results of a multicenter study

Analysis of the results of daptomycin antibiotic therapy and surgical treatment of 37 patients with infective endocarditis (IE) admitted to three Moscow hospitals during 2012 to 2016 is presented. Primary endocarditis was diagnosed in 32.4% of the cases. The secondary forms of the disease dominated by endocarditis following cardiac surgery (29.7%) including valve prosthetics and implantation of pacemaker/cardioverter-defibrillator (PM/CVD). Positive reaction in 2 or more blood cultures was observed in 73% of the patients with the prevalence of Staphylococcus aureus (27%). Vegetation at TT and emergency echocardiography was documented in 89.2% of the patients, fibrous ring or leaflet abscesses in 24.3%). All patients were treated with daptomycin at an average dose of 6,7 ± 0,7 mg/kg b w. The duration of therapy was 26,7 ± 9,8 days. Surgical treatment was given to 48.6% of the patients including PM/CVD replacement in 5.4%. Surgical mortality was absent. Hospital mortality amounted to 13.5%. The use of daptomycin in combination with surgical treatment can significantly improve the results of treatment of this serious disease.

Training for emergency echocardiography

Emergency echocardiography refers to the use of echocardiography in the assessment of patients with suspected cardiovascular disease requiring immediate diagnosis and treatment. The European Association of Cardiovascular Imaging (EACVI) has recently set standards for adequate education and training for the safe and efficient use of echocardiography in emergency cardiac care. The level of competence in echocardiography required for emergency cases is at least the same as for elective cases and competence requirements for emergency echocardiography are the same for cardiologists and non-cardiologists. The EACVI recognizes two levels of competence in emergency echocardiography: the independent operator level and the expert operator level. This chapter discusses general considerations as well as requirements and levels of competence regarding training for emergency echocardiography.