FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / J Vet Intern Med / Feasibility of a point-of-care ultrasound protocol for cardi...
Journal of veterinary internal medicine2023; 37(3); 1223-1232; doi: 10.1111/jvim.16674

Feasibility of a point-of-care ultrasound protocol for cardiorespiratory evaluation of horses in different clinical settings.

Abstract: A point-of-care ultrasound (POCUS) protocol for evaluation of the cardiac and respiratory systems in horses does not exist. Objective: (a) Describe the windows of a POCUS protocol for cardiorespiratory assessment of horses (CRASH); (b) Estimate the number of acoustic windows that can be acquired by a sonographer-in-training; (c) Estimate the time required to complete the protocol for specific groups of horses; (d) Describe the sonographic abnormalities detected in horses presented with cardiovascular, respiratory, or systemic disease. Methods: Twenty-seven healthy horses, 14 horses competing in athletic events, and 120 horses with clinical disease. Methods: A pocket-sized ultrasound device was used to acquire 7 sonographic cardiorespiratory windows in various clinical scenarios. The duration of the examination was timed, and images were evaluated for diagnostic quality. Abnormalities in horses with clinical disease were determined by an expert sonographer. Results: The CRASH protocol could be performed in healthy and diseased horses in hospital, barn, and competition settings between 5.5 ± 0.9 (athletic horses) and 6.9 ± 1.9 min (horses with clinical disease). Thoracic windows were obtained most consistently, followed by right parasternal long-axis echocardiographic windows. Frequently detected abnormalities were pleural fluid, lung consolidation, B-lines, and moderate-to-severe left-sided heart disease. Conclusions: The CRASH protocol was feasible using a pocket-sized ultrasound device in various groups of horses, could be completed rapidly in a variety of settings, and frequently identified sonographic abnormalities when evaluated by an expert sonographer. The diagnostic accuracy, observer agreement, and utility of the CRASH protocol merit further evaluation.
© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Get Full Text
Publication Date: 2023-03-28 PubMed ID: 36975771PubMed Central: PMC10229348DOI: 10.1111/jvim.16674Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research aims to test the practicality of using a point-of-care ultrasound (POCUS) protocol for evaluating the cardiac and respiratory systems in horses in varying environments. The results showed the protocol can be rapidly completed in a variety of settings, often identifying diseases when evaluated by an expert sonographer.

Objective of the Research

The paper focuses on four key objectives:

  • To describe the specific points or ‘windows’ used in the POCUS protocol for the cardiorespiratory assessment of horses, a method dubbed CRASH.
  • To estimate the number of these windows that a trainee sonographer can acquire–the more windows, the more comprehensive the assessment.
  • To estimate the time required to complete the protocol for different types of horses–healthy, athletic, and diseased.
  • To document and describe the abnormalities detected in horses with cardiovascular, respiratory, or systemic disease using the CRASH protocol.

Methodology

  • The research was carried out using twenty-seven healthy horses, fourteen athletic horses, and one hundred and twenty diseased horses.
  • A pocket-sized ultrasound device was utilized to acquire seven sonographic cardiorespiratory windows in various clinical scenarios.
  • The duration of each examination was timed to estimate the speed of completing the whole protocol.
  • The sonographic images acquired were evaluated for diagnostics quality.
  • A sonography expert determined the abnormalities detected in horses with clinical diseases.

Results

  • The researchers found that the CRASH protocol could be performed both on healthy and diseased horses in hospital, barn, and competition settings, taking between 5.5 ± 0.9 minutes for the athletic horses and 6.9 ± 1.9 minutes for the horses with clinical disease.
  • The most consistently obtained windows were thoracic, followed by right parasternal long-axis echocardiographic ones.
  • The most common anomalies found were pleural fluid, lung consolidation, B-lines, and moderate-to-severe left-sided heart disease.

Conclusion

  • In conclusion, the CRASH protocol using a pocket-sized ultrasound device was found to be feasible for different horse groups and could be administered in multiple settings.
  • The researchers found that it could often identify sonographic abnormalities when evaluated by an expert sonographer.
  • However, they suggest further evaluation to determine the diagnostic accuracy, observer agreement, and overall practical utility of the CRASH protocol.

Cite This Article

APA
Bevevino KE, Cohen ND, Gordon SG, Navas de Solis C. (2023). Feasibility of a point-of-care ultrasound protocol for cardiorespiratory evaluation of horses in different clinical settings. J Vet Intern Med, 37(3), 1223-1232. https://doi.org/10.1111/jvim.16674

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 37
Issue: 3
Pages: 1223-1232

Researcher Affiliations

Bevevino, Kari E
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas 77843, USA.
Cohen, Noah D
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas 77843, USA.
Gordon, Sonya G
  • Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas 77843, USA.
Navas de Solis, Cristobal
  • Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania 19348, USA.

MeSH Terms

  • Horses
  • Animals
  • Point-of-Care Systems
  • Feasibility Studies
  • Ultrasonography / veterinary
  • Ultrasonography / methods
  • Point-of-Care Testing
  • Echocardiography / veterinary

Grant Funding

  • American College of Veterinary Internal Medicine Clinical Training Fellowship
  • Texas A&M University Department of Large Animal Clinical Sciences
  • Texas A&M University Link Equine Research Endowment

Conflict of Interest Statement

Authors declare no conflict of interest.

References

This article includes 42 references
  1. Baston CM, Wallace P, Chan W, Dean AJ, Panebianco N. Innovation Through Collaboration: Creation of a Combined Emergency and Internal Medicine Point-of-Care Ultrasound Fellowship.. J Ultrasound Med 2019 Aug;38(8):2209-2215.
    pubmed: 30592332doi: 10.1002/jum.14908google scholar: lookup
  2. Luong CL, Ong K, Kaila K, Pellikka PA, Gin K, Tsang TSM. Focused Cardiac Ultrasonography: Current Applications and Future Directions.. J Ultrasound Med 2019 Apr;38(4):865-876.
    pubmed: 30146784doi: 10.1002/jum.14773google scholar: lookup
  3. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T. International evidence-based recommendations for point-of-care lung ultrasound.. Intensive Care Med 2012 Apr;38(4):577-91.
    pubmed: 22392031doi: 10.1007/s00134-012-2513-4google scholar: lookup
  4. Xue H, Li C, Cui L, Tian C, Li S, Wang Z, Liu C, Ge Q. M-BLUE protocol for coronavirus disease-19 (COVID-19) patients: interobserver variability and correlation with disease severity.. Clin Radiol 2021 May;76(5):379-383.
    pmc: PMC7888246pubmed: 33663912doi: 10.1016/j.crad.2021.02.003google scholar: lookup
  5. Liu J, Copetti R, Sorantin E, Lovrenski J, Rodriguez-Fanjul J, Kurepa D, Feng X, Cattaross L, Zhang H, Hwang M, Yeh TF, Lipener Y, Lodha A, Wang JQ, Cao HY, Hu CB, Lyu GR, Qiu XR, Jia LQ, Wang XM, Ren XL, Guo JY, Gao YQ, Li JJ, Liu Y, Fu W, Wang Y, Lu ZL, Wang HW, Shang LL. Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus.. J Vis Exp 2019 Mar 6;(145).
    pubmed: 30907892doi: 10.3791/58990google scholar: lookup
  6. Bergmann KR, Arroyo AC, Tessaro MO, Nielson J, Whitcomb V, Madhok M, Yock-Corrales A, Guerrero-Quesada G, Chaudoin L, Berant R, Shahar-Nissan K, Deanehan JK, Lam SHF, Snelling PJ, Avendano P, Cohen SG, Friedman N, Ekpenyong A, Pade KH, Park DB, Lin-Martore M, Kornblith AE, Montes-Amaya G, Thomas-Mohtat R, Jin J, Watson D, Sivitz A. Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception: A Multicenter, Noninferiority Study of Paired Diagnostic Tests.. Ann Emerg Med 2021 Nov;78(5):606-615.
    pubmed: 34226072doi: 10.1016/j.annemergmed.2021.04.033google scholar: lookup
  7. Hori Y, Yamashita Y, Sakakibara K, Sano T, Hori A. Usefulness of pericardial lung ultrasonography for the diagnosis of cardiogenic pulmonary edema in dogs.. Am J Vet Res 2020 Mar;81(3):227-232.
    pubmed: 32101047doi: 10.2460/ajvr.81.3.227google scholar: lookup
  8. Vientós-Plotts AI, Wiggen KE, Lisciandro GR, Reinero CR. The utility of point-of-care ultrasound right-sided cardiac markers as a screening test for moderate to severe pulmonary hypertension in dogs.. Vet J 2019 Aug;250:6-13.
    pubmed: 31383421doi: 10.1016/j.tvjl.2019.05.013google scholar: lookup
  9. Darnis E, Merveille AC, Desquilbet L, Boysen S, Gommeren K. Interobserver agreement between non-cardiologist veterinarians and a cardiologist after a 6-hour training course for echographic evaluation of basic echocardiographic parameters and caudal vena cava diameter in 15 healthy Beagles.. J Vet Emerg Crit Care (San Antonio) 2019 Sep;29(5):495-504.
    pubmed: 31453666doi: 10.1111/vec.12883google scholar: lookup
  10. Oricco S, Rabozzi R, Meneghini C, Franci P. Usefulness of focused cardiac ultrasonography for predicting fluid responsiveness in conscious, spontaneously breathing dogs.. Am J Vet Res 2019 Apr;80(4):369-377.
    pubmed: 30919671doi: 10.2460/ajvr.80.4.369google scholar: lookup
  11. Loughran KA, Rush JE, Rozanski EA, Oyama MA, Larouche-Lebel É, Kraus MS. The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats.. J Vet Intern Med 2019 Sep;33(5):1892-1901.
    pmc: PMC6766524pubmed: 31317580doi: 10.1111/jvim.15549google scholar: lookup
  12. Tse YC, Rush JE, Cunningham SM, Bulmer BJ, Freeman LM, Rozanski EA. Evaluation of a training course in focused echocardiography for noncardiology house officers.. J Vet Emerg Crit Care (San Antonio) 2013 May-Jun;23(3):268-73.
    pubmed: 23647602doi: 10.1111/vec.12056google scholar: lookup
  13. Diamantino AC, Nascimento BR, Nunes MCP, Sable CA, Oliveira KKB, Rabelo LC, Franco J, Diamantino LC, Barbosa MM, Reese AT, Olivieri L, de Lima EM, Martins LNA, Colosimo EA, Beaton AZ, Ribeiro ALP. Impact of incorporating echocardiographic screening into a clinical prediction model to optimise utilisation of echocardiography in primary care.. Int J Clin Pract 2021 Mar;75(3):e13686.
    pubmed: 32852108doi: 10.1111/ijcp.13686google scholar: lookup
  14. Mantuani D, Frazee BW, Fahimi J, Nagdev A. Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea.. West J Emerg Med 2016 Jan;17(1):46-53.
    pmc: PMC4729418pubmed: 26823930doi: 10.5811/westjem.2015.11.28525google scholar: lookup
  15. Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.. J Am Soc Echocardiogr 2013 Jun;26(6):567-81.
    pubmed: 23711341doi: 10.1016/j.echo.2013.04.001google scholar: lookup
  16. Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians.. J Am Soc Echocardiogr 2010 Dec;23(12):1225-30.
    pubmed: 21111923doi: 10.1016/j.echo.2010.10.005google scholar: lookup
  17. Via G, Hussain A, Wells M, Reardon R, ElBarbary M, Noble VE, Tsung JW, Neskovic AN, Price S, Oren-Grinberg A, Liteplo A, Cordioli R, Naqvi N, Rola P, Poelaert J, Guliĉ TG, Sloth E, Labovitz A, Kimura B, Breitkreutz R, Masani N, Bowra J, Talmor D, Guarracino F, Goudie A, Xiaoting W, Chawla R, Galderisi M, Blaivas M, Petrovic T, Storti E, Neri L, Melniker L. International evidence-based recommendations for focused cardiac ultrasound.. J Am Soc Echocardiogr 2014 Jul;27(7):683.e1-683.e33.
    pubmed: 24951446doi: 10.1016/j.echo.2014.05.001google scholar: lookup
  18. Busoni V, De Busscher V, Lopez D, Verwilghen D, Cassart D. Evaluation of a protocol for fast localised abdominal sonography of horses (FLASH) admitted for colic.. Vet J 2011 Apr;188(1):77-82.
    pubmed: 20347357doi: 10.1016/j.tvjl.2010.02.017google scholar: lookup
  19. Vincze B, Baska F, Papp M, Szenci O. Introduction of a new fetal examination protocol for on-field and clinical equine practice.. Theriogenology 2019 Feb;125:210-215.
    pubmed: 30469011doi: 10.1016/j.theriogenology.2018.11.004google scholar: lookup
  20. Eberhardt C, Schwarzwald CC. Focused cardiac ultrasound examination in the emergency and critical care horse: Training for non-specialist veterinarians and evaluation of proficiency.. J Vet Intern Med 2022 Jul;36(4):1471-1480.
    pmc: PMC9308440pubmed: 35657023doi: 10.1111/jvim.16446google scholar: lookup
  21. Schwarzwald CC. Equine Echocardiography.. Vet Clin North Am Equine Pract 2019 Apr;35(1):43-64.
    pubmed: 30826106doi: 10.1016/j.cveq.2018.12.008google scholar: lookup
  22. Partlow J, David F, Hunt LM, Relave F, Blond L, Pinilla M, Lavoie JP. COMPARISON OF THORACIC ULTRASONOGRAPHY AND RADIOGRAPHY FOR THE DETECTION OF INDUCED SMALL VOLUME PNEUMOTHORAX IN THE HORSE.. Vet Radiol Ultrasound 2017 May;58(3):354-360.
    pubmed: 28264227doi: 10.1111/vru.12480google scholar: lookup
  23. Byars TD, Becht JL. Pleuropneumonia.. Vet Clin North Am Equine Pract 1991 Apr;7(1):63-78.
    pubmed: 2054710doi: 10.1016/s0749-0739(17)30516-3google scholar: lookup
  24. Reimer JM, Reef VB, Spencer PA. Ultrasonography as a diagnostic aid in horses with anaerobic bacterial pleuropneumonia and/or pulmonary abscessation: 27 cases (1984-1986).. J Am Vet Med Assoc 1989 Jan 15;194(2):278-82.
    pubmed: 2645254
  25. Deacon LJ, Reef VB, Leduc L, de Solis CN. Pocket-Sized Ultrasound Versus Traditional Ultrasound Images in Equine Imaging: A Pictorial Essay.. J Equine Vet Sci 2021 Sep;104:103672.
    pubmed: 34416998doi: 10.1016/j.jevs.2021.103672google scholar: lookup
  26. Williams ZJ, Sage A, Valberg SJ. Hand-Held Point-of-Care Ultrasound: A New Tool for Veterinary Student Self-Driven Learning in the Time of COVID-19.. J Vet Med Educ 2022 Jun;49(3):306-311.
    pubmed: 33970815doi: 10.3138/jvme-2020-0131google scholar: lookup
  27. Decloedt A, Borowicz H, Slowikowska M, Chiers K, van Loon G, Niedzwiedz A. Right ventricular function during acute exacerbation of severe equine asthma.. Equine Vet J 2017 Sep;49(5):603-608.
    pubmed: 28132404doi: 10.1111/evj.12675google scholar: lookup
  28. Johansson AM, Gardner SY, Atkins CE, LaFevers DH, Breuhaus BA. Cardiovascular effects of acute pulmonary obstruction in horses with recurrent airway obstruction.. J Vet Intern Med 2007 Mar-Apr;21(2):302-7.
    pubmed: 17427392doi: 10.1892/0891-6640(2007)21[302:ceoapo]2.0.co;2google scholar: lookup
  29. Keene BW, Atkins CE, Bonagura JD, Fox PR, Häggström J, Fuentes VL, Oyama MA, Rush JE, Stepien R, Uechi M. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs.. J Vet Intern Med 2019 May;33(3):1127-1140.
    pmc: PMC6524084pubmed: 30974015doi: 10.1111/jvim.15488google scholar: lookup
  30. Huesler IM, Mitchell KJ, Schwarzwald CC. Echocardiographic Assessment of Left Atrial Size and Function in Warmblood Horses: Reference Intervals, Allometric Scaling, and Agreement of Different Echocardiographic Variables.. J Vet Intern Med 2016 Jul;30(4):1241-52.
    pmc: PMC5108425pubmed: 27362277doi: 10.1111/jvim.14368google scholar: lookup
  31. Marr CM. Equine Acquired Valvular Disease.. Vet Clin North Am Equine Pract 2019 Apr;35(1):119-137.
    pubmed: 30871831doi: 10.1016/j.cveq.2018.12.001google scholar: lookup
  32. Reef VB. Thoracic ultrasonography: noncardiac imaging. In: Reef VB, ed. Equine Diagnostic Ultrasound. Vol 1. Philadelphia, PA: Elsevier Saunders; 1998:187‐214.
  33. Underwood C, Norton JL, Nolen-Walston RD, Dallap-Schaer BL, Boston R, Slack J. Echocardiographic changes in heart size in hypohydrated horses.. J Vet Intern Med 2011 May-Jun;25(3):563-9.
    pubmed: 21039870doi: 10.1111/j.1939-1676.2010.0612.xgoogle scholar: lookup
  34. Navas de Solis C, Slack J, Boston RC, Reef VB. Hypertensive cardiomyopathy in horses: 5 cases (1995-2011).. J Am Vet Med Assoc 2013 Jul 1;243(1):126-30.
    pubmed: 23786201doi: 10.2460/javma.243.1.126google scholar: lookup
  35. Henneke DR, Potter GD, Kreider JL, Yeates BF. Relationship between condition score, physical measurements and body fat percentage in mares.. Equine Vet J 1983 Oct;15(4):371-2.
    pubmed: 6641685doi: 10.1111/j.2042-3306.1983.tb01826.xgoogle scholar: lookup
  36. Duanmu Y, Henwood PC, Takhar SS, Chan W, Rempell JS, Liteplo AS, Koskenoja V, Noble VE, Kimberly HH. Correlation of OSCE performance and point-of-care ultrasound scan numbers among a cohort of emergency medicine residents.. Ultrasound J 2019 Mar 5;11(1):3.
    pmc: PMC6638613pubmed: 31359167doi: 10.1186/s13089-019-0118-7google scholar: lookup
  37. Yim ES, Kao D, Gillis EF, Basilico FC, Corrado GD. Focused physician-performed echocardiography in sports medicine: a potential screening tool for detecting aortic root dilatation in athletes.. J Ultrasound Med 2013 Dec;32(12):2101-6.
    pubmed: 24277891doi: 10.7863/ultra.32.12.2101google scholar: lookup
  38. Yim ES, Gillis EF, Ojala K, MacDonald J, Basilico FC, Corrado GD. Focused transthoracic echocardiography by sports medicine physicians: measurements relevant to hypertrophic cardiomyopathy.. J Ultrasound Med 2013 Feb;32(2):333-8.
    pubmed: 23341391doi: 10.7863/jum.2013.32.2.333google scholar: lookup
  39. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006.. Circulation 2009 Mar 3;119(8):1085-92.
    pubmed: 19221222doi: 10.1161/circulationaha.108.804617google scholar: lookup
  40. Physick-Sheard PW, Slack J. Irregular hearts and performance horses.. Equine Vet J 2020 Nov;52(6):782-786.
    pubmed: 33017494doi: 10.1111/evj.13316google scholar: lookup
  41. Corrado D, Pelliccia A, Bjørnstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology.. Eur Heart J 2005 Mar;26(5):516-24.
    pubmed: 15689345doi: 10.1093/eurheartj/ehi108google scholar: lookup
  42. de Solis CN, Althaus F, Basieux N, Burger D. Sudden death in sport and riding horses during and immediately after exercise: A case series.. Equine Vet J 2018 Sep;50(5):644-648.
    pubmed: 29330860doi: 10.1111/evj.12803google scholar: lookup

Citations

This article has been cited 1 times.
  1. Balakrishnan A, Silverstein DC, Bedenice D, Bersenas A, Bourgeois JP, Carroll CL, Dunkel B, Greensmith T, Hopper K, Lascola K, Mangalmurti N, Rozanski E, Wilkins P, Yehya N. Acute Respiratory Distress Syndrome in Veterinary Medicine-The ARDSVet Definitions. J Vet Emerg Crit Care (San Antonio) 2025 Jul-Aug;35(4):327-338.
    doi: 10.1111/vec.70016pubmed: 40838381google scholar: lookup
Subscribe to our newsletter
Join 99,344 horse owners like you who receive our email updates on horse health and nutrition.