Emergency physicians can reliably assess emergency department patient cardiac output using the USCOM continuous wave Doppler cardiac output monitor

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Abstract
1 To develop a training package for ultrasonic cardiac output monitor (USCOM) cardiac output assessments and determine the number of proctored studies necessary for skill acquisition. 2 To develop criteria for acceptance of cardiac output results obtained with the USCOM. 3 To evaluate the reliability of USCOM cardiac output assessments in the ED. The authors developed an audiovisual training package. Four emergency physicians and one geriatrician subsequently underwent hands-on training, and skill acquisition was assessed at the fifth, 10th, 15th and 20th examinations. Six image-scoring criteria were developed to assess acoustic image quality. Upon completion of training a protocol was developed to optimize interassessor reliability. Two trained emergency physicians then performed blinded examinations on ED patients using the protocol and interassessor reliability was evaluated. During training average image score improved between the fifth and 20th assessed patient from 4.6 (95% CI 4.0-5.3) to 5.5 (95% CI 5.0-6.0, Pt-test=0.02) out of 6 and average intra-assessor cardiac output difference improved from 17% (95% CI 4-25) to 5% (95% CI 0-11, Pt-test=0.02). Analysis of 52 cardiac output assessments in 21 ED patients demonstrated excellent interassessor correlation (r=0.96, 95% CI 0.90-0.98, P<0.001). The average interassessor difference in cardiac output and index was 0.2 L/min (4%, 95% CI 3-6) and 0.1 L/min/m2 (4%, 95% CI 2-6), respectively. Emergency physicians with no prior ultrasonographic experience can be trained to obtain reliable cardiac output estimations upon conscious ED patients with the USCOM over the course of 20 patient assessments.