REVIEW ARTICLE Review article: Clinical impact of non-cardiologist-performed transthoracic echocardiography in emergency medicine, intensive care medicine and anaesthesia Darsim L Haji, 1,2 Alistair Royse 3 and Colin F Royse 4 1 Emergency Department, Frankston Hospital, Frankston, Victoria, Australia, 2 Department of Pharmacology, Ultrasound Education Group, The University of Melbourne, Melbourne, Victoria, Australia, 3 Department of Surgery, Ultrasound Education Group, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Victoria, Australia, and 4 Anaesthesia and Pain Management Unit, Department of Pharmacology, Ultrasound Education Group, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Victoria, Australia Abstract There is increased realisation of the emerging role of point-of-care transthoracic echocar- diography (TTE) as ‘ultrasound-assisted examination’, given the low sensitivity of clinical examination for cardiovascular pathologies and the time-critical nature of these patholo- gies. There is evidence that point-of-care TTE provides higher accuracy in patient assess- ment and management, with potential prognostic impact by assessing the severity of cardiac dysfunction and response to treatment. Point-of-care TTE is increasingly used by non-cardiologists, as a diagnostic, screening or monitoring tool. The literature shows that TTE identifies new clinical findings, and conversely can accurately rule out clinically important pathologies. Recent reports have examined more advanced ultrasound devices and patients in the critical care settings of emergency medicine, intensive care and anaes- thesia. The diagnostic capability of new portable devices is improving rapidly and outdat- ing its predecessors, thereby improving confidence in echocardiography findings. Key words: critical illness, emergency medical services, point-of-care system, transthoracic echocardiography. Introduction The first echocardiography machine was developed more than 50 years ago. 1 Since then ultrasound technol- ogy has seen significant development, allowing echocar- diographic examination of critically ill patients at the bedside by cardiologists and non-cardiologists. The ease of performing bedside studies has been significantly facilitated by smaller portable machines with high-quality imaging. It is sometimes referred to as ‘point-of-care’ transthoracic echocardiography (TTE) examination, which is often goal-focused – with the aim of answering specific clinical questions. Conceptually though, it might be considered as ‘ultrasound-assisted examination’ and the findings can be integrated into the clinical diagnosis and interpreted within the context of Correspondence: Dr Darsim L Haji, Department of Pharmacology, Ultrasound Education Group, The University of Melbourne, 245 Cardigan Street, Carlton, Vic. 3053, Australia. Email: darsim@bigpond.com Darsim L Haji, MBChB, FACEM, PGradDip Critical Care Echocardiography, Emergency Medicine Physician; Alistair Royse, MBBS, MD, FRACS, Professor and Cardiothoracic Surgeon; Colin F Royse, MBBS, MD, FRANZCA, Professor and Director, Cardiothoracic Anaesthetist. doi: 10.1111/1742-6723.12033 Emergency Medicine Australasia (2013) 25, 4–12 © 2012 The Authors EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine