Critical care echocardiography: barriers, competencies and solutions. A survey of over 600 participants

BACKGROUND: Critical care echocardiography (CCE) is at the core of point-of-care ultrasound (POCUS), and although a list of the necessary competencies has been created, most European countries do not have established training programmes to allow intensivists to gain such competencies. To address barriers to the implementation of CCE, we conducted an online European survey, and analysed the current barriers to this with the aim of providing novel, modern solutions to them including environmental considerations. METHODS: A 23-item survey was distributed via email with support from the European Society of Intensive Care Medicine, national societies, and social media. Questions focused on bedside CCE prevalence, competencies, and barriers to its implementation. An additional questionnaire was sent to recognised experts in the field of CCE. RESULTS: A total of 644 responses were recorded. Most respondents were anaesthesia and intensive care physicians [79% (n = 468)], and younger, with 56% in their first five years after specialization (n = 358). Most respondents [92% (n = 594)] had access to an ultrasound machine with a cardiac probe, and 97% (n = 623) reported being able to acquire basic CCE windows. The most common barriers identified by respondents to the implementation of CCE in practice were a lack of sufficient experience/skill [64% (n = 343)], absence of formal qualifications [46% (n = 246)] and lack of a mentor [45% (n = 243)]. Twenty-eight experts responded and identified a lack of allocated time for teaching as a main barrier [60% (n = 17)]. CONCLUSIONS: We found that bedside CCE is perceived as a crucial skill for intensive care medicine, especially by younger physicians; however, there remain several obstacles to training and implementation. The most important impediments reported by respondents were inadequate training, absence of formal qualifications and difficulties in finding a suitable mentor.