Focused Cardiac Ultrasound in the Pediatric Perioperative Setting

Karen R. Boretsky, MD; David B. Kantor, MD, PhD; James A. DiNardo, MD; Achikam Oren-Grinberg, MD


Anesth Analg. 2019;129(4):925-932. 

In This Article

Basic Equipment Requirements

Ultrasound platforms suitable for FoCUS range widely in imaging capability, size, and cost and include mobile systems on wheels to hand-held or pocket-sized devices.[6,16,28] An ultrasound device for bedside FoCUS needs to be compact and portable and capable of providing 2-dimensional (2D) imaging. While M-Mode is desirable, it is not deemed essential to basic FoCUS imaging.[6,16,28]

The ultrasound device must have the ability to save still images and video clips and ideally perform simple measurements. Still images and videos stored on the device should be transferred to institutions' imaging databases and/or to patient medical records to allow review at a later time.

FoCUS is performed with phased array transducers. Phased array transducers have a small footprint to allow visualization of deep structures through a small acoustic window. They are ideal for scanning windows that are limited to intercostal spaces. Phased array transducers can be shaped as curved or linear. For perioperative pediatric FoCUS, a single linear phased array transducer oscillating at frequencies from 3.0 to 5.0 MHz with a footprint of 2–3 cm2 produces satisfactory image quality in all children, including young infants, without the need for an extensive and costly collection of transducers. Having a single transducer for emergent use eliminates the need to choose, locate, and change transducers, which can otherwise create a distraction and waste valuable time during emergent situations. If a phased array is not available, a low-frequency curvilinear transducer can be used for imaging through the subcostal window. The curvilinear transducer has a footprint that is too large for viewing between ribs for the apical and parasternal windows.