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https://www.youtube.com/watch?v=KJplylCTQXs
Transcript

- Hi everyone.

Welcome to the demo today. We'll begin in just a moment.

Great. Thank you for joining us.

We'll begin in just a moment.

I'm just letting people populate the room here.

Wonderful. Thank you for joining us. Excellent.

Welcome to our live demo on assisted cardiac output

with the Sono site px.

Streamline your Fluid responsiveness evaluations.

Please be advised we all attendees are muted

and you may type your questions into the q

and a box in the toolbar located at the bottom

or side of your screen at any time.

We will conduct a q and a session at the end

of the presentation and demonstration

and this webinar will be recorded

and archived for future reference.

Our presenters today are Audra Upton and Kimberly Warren.

Warren is here, she's not going to speak

but she's behind the scenes helping with the scanning.

Audra Upton is the director of Clinical Applications team

with more than 13 years of experience at Fujifilm Sono site.

She graduated from the University of Oklahoma

with a degree in ultrasound

and IS register is a registered cardiac

and vascular sonographer.

Audra and her team remain customer focused

and are specialized in providing top level point

of care ultrasound education.

And Kim Warren is a,

Kim Warren is the clinical application specialist

for Fuji Foam sono site in Minnesota.

She has been a sonographer for 10 years

and is currently registered in vascular and abdomen.

Audra, I'm gonna turn it over to you to get started.

- Thank you so much Laura.

Thank you for joining us today As we go

through the A CO calculation, the new, a new calculation

that we've added onto Sauna Site px.

I do just wanna say first

because we are not gonna be doing a full fledged demo

of the system today.

However, we do have different webinars on our website

that you can go back and rewatch

and we have full demos of that.

We have some other topics as well that really goes into

a deeper dive into the Sauna Site PX system.

And then of course, if at any point you're interested in

having a one-on-one virtual demo,

we would be more than happy to set that up with you.

And then also we're more than happy

to bring the system on site if your facility

is allowing that.

Okay, we're gonna go ahead and get started.

Before we jump into the calculation itself, I do just want

to give a brief overview

of the interface of what you're seeing.

So if you're, if you're new to Cyte px,

it is a hybrid ultrasound system.

And so what you'll notice is that on the interface itself,

the top three fourths of the interface is a touch screen.

And then the bottom fourth is our tactile keys

and what you're gonna notice about the tactile keys,

these keys are persistent keys

and they are the most commonly used parameters

that you are gonna use to optimize your ultrasound image.

And that's independent of transducer chosen

or exam types.

You'll also notice that they are uniquely shaped

and that was done on purpose, that was with intention

and that really is so that

as a clinician you can have your focus on your patient

and you can easily reach back over with your hand

and know based on the shape

and location of the button, which parameter it is

that you're gonna be optimizing.

Taking a closer look at the touch panel,

you'll notice that this is our startup screen

and so it's gonna ask you how would you like to start?

If you'd like to go straight into scanning,

you can certainly choose to do so.

You can select patient information, your transducer

and exam type, and then we do have onboard learning on the

PX system as well.

And that is a really great feature if you're in a teaching

facility because it does allow you

to watch some different modules as well

as scan along real time.

For today, we're gonna go straight into scan.

Now as I mentioned,

those tactile keys are gonna be those persistent keys,

those most commonly used parameters.

However, on the touch panel itself, what you will notice is

that this panel is going

to adapt based on the transducer chosen

and the exam types selected.

So if you take a look, we are currently scanning

with our P five one transducer,

that's our phased array transducer

and we are scanning under our focused cardiac exam type.

I'm gonna have Kim go ahead and go to that transducer page.

You'll see that currently we have three different

transducers plugged in.

We're gonna stay focused on the phased array today,

but we do have both a focused cardiac as well

as a cardiac exam type.

If Kim selects that cardiac exam type

and hits scan, what you will notice is that the options in

that mini min middle section, I apologize, middle section,

are now updated.

And it's because the system is anticipating your workflow

based on the exam type chosen.

So if you are choosing to scan under cardiac,

the system is assuming

that you want a full fledge deeper dive into cardiac

scanning, a more robust calculation package,

just some more manipulations of sector size,

things of that nature.

If you wanna keep it more simplified

and very specific,

then I would recommend scanning under focused cardiac.

Before we switch over to that,

I am gonna have Kim go in just briefly

and show the calculation package

and the way that we have it designed for sauna site px.

So you'll notice she hit the calc button.

It now takes each one of really,

I look at it into individual categories.

We really have tried to simplify this.

So if you know that you wanna look at LV function

or RV function, you simply find that button that tells you

what it is that you're looking to calculate.

You would select one of those

and then you would see built in underneath.

You can go ahead and select diastolic

or yeah, RV function, that's fine.

So you'll see all the different ways

that you can evaluate a patient's RV function using

sauna cyte px.

Now, right now those are grayed out

because we're in 2D imaging mode,

but if we were live in Doppler

or we had a frozen image, you would see some

of those options come back open.

Now one thing that I do wanna point out while we're in the

calculation package is in regards to workflow,

oftentimes you'll grab a machine

and you'll start scanning only to find out

that once you hit packages

that you actually don't see the calculation package

that you wanted to see.

Cyte PX now offers the ability to go backwards to all

of the parent packages that are applicable to

that the transducer that you're scanning with.

So you can see Kim easily went back to packages.

Now if I wanted to scan with focused cardiac calculations,

I absolutely can do that.

I can just select focused cardiac

and now I have a much more simplified interface,

more simplified calculations.

Now today we are specifically going

to be talking about assisted cardiac output

and using ultrasound in com in combination

with a fluid challenge.

So whether that's a passive leg raise

or a fluid bolus, this really can be a non-invasive cost

and time effective modality that really can be employed

to assess volume status and response to fluid resuscitation.

And that's what we're gonna be talking about today with you.

So if you've ever performed a traditional cardiac output,

I'm gonna actually go ahead and switch over

to some live scanning here.

So what we're seeing here is the per sternal long axis view.

And as I was saying, if you've ever tried

to scan a traditional cardiac output, you know

that at times it can be a very tedious complex

measurement to try to get.

And what we have done

with the assisted cardiac output measurement is we've really

removed the challenging aspect of the calculation.

And in a moment you're gonna see for yourself the ability

that this measurement has to do some of the auto measurement

for you, auto tracing for you.

And it's really gonna simplify the process.

It also allows you to get

what I consider the most bang for your buck.

And what I mean by that is we've incorporated the ability

to not only look at cardiac output from a, just

how well the heart is functioning,

but we've incorporated it with a pre

and post fluid challenge.

So at the same time,

if you do wanna evaluate your patient's fluid

responsiveness, we now have the ability to do that.

And so performing one measurement is actually,

or one calculation is actually gonna give you multiple

layers of information.

So what we're seeing here, this is

how you're gonna start anytime you do a cardiac output,

you have to always start

by getting your left ventricular outflow tract diameter.

So just since I don't know who all has joined

and the knowledge level of everybody,

I'm just gonna break down

what it is exactly that we're seeing.

So we are scar scanning that per sternal long axis view.

Kim has, Kim is actually in her home in Minnesota

and she got one of her her children

to actually let us scan her.

So thank you very much for that.

But what she's doing is she's actually scanning just

to the left of the sternum around the third

or fourth intercostal space with the indicator notch

of the transducer pointed to the patient's right shoulder.

And doing that gives us the peroneal long axis view.

So what we're seeing here is left atrium, Kim's gonna use

that arrow and point out some anatomy for us.

Left atrium, we have mitral valve, we have left ventricle,

we then have our aortic valve

and then we also have that LVOT diameter

and that's really the area

that we're gonna be focusing on and measuring today.

Just above that is the rv.

There we go. And then of course that bright white line

underneath that posterior wall is our pericardium.

Okay, so focusing in on the

LVOT, you can do a couple of things.

If you wanted to zoom up on it, you certainly could do that

to where you really are just focusing on that area.

We want to measure this area when the aortic valve is open.

So Kim is going to freeze that image.

Now the nice thing with sauna side PX is we do have the

ability to use a cine buffer.

So where we can rewind the image back to where

that valve is completely open,

she's now gonna go into the calc package, she's going

to select that assisted cardiac output.

And you're gonna notice that the L-V-O-T-D

or diameter is the only active calculation available to us

and that's because we're in the frozen 2D image.

So she's gonna select that when she does that,

it's gonna bring up a set of calipers up on the screen

or one caliper, she's gonna place that first cper

and you're gonna measure inner to inner wall

and she's gonna hit select, that's gonna bring up

that second cper, she's gonna move that straight down.

You'll notice that that measurement is displayed now in the

upper left hand corner of the imaging monitor.

So 1.85 centimeters.

She's now gonna hit the camera on the PX

and that's gonna store it in the calculation.

Once we have that done, now we are gonna move actually

to the apical five chamber view.

So I'm gonna give her just a moment

to get her daughter positioned.

The indicator now is gonna be pointing really kind

of at three o'clock or down towards the patient's bed.

If you have the ability to fill for the patient's PMI,

that's always an easy way

'cause apical windows can be a little difficult at times.

Once you find that apical four chamber,

you're actually just going

to angle the transducer a little anteriorly

or drop the tail of the transducer

and that's gonna bring in

that left vent ventricular outflow tract.

I like to use color here, it's not mandatory,

but anytime you have a an image that's a little bit harder

to see, you can really help identify that LVOT.

With the help of color, she's now gonna hit D or Doppler

and she's gonna place that doppler waveform really in the

same exact spot that we measured the diameter.

And then she's gonna hit D again, this is going

to give us a waveform.

And now normally you would hear this,

she is on mute today since we're doing the webinar

and I'm the one speaking, but typically you would hear it

and then what we're gonna do,

and this is, this is where the magic happens

with the A CO calculation.

So actually as she is scanning live,

she's gonna go back into the calc package

and what you're gonna see is you are gonna see the ability

to look at the patient both pre and post a fluid challenge.

So right now you can see pre is already selected.

And going back to that image,

I'm gonna let her update her image just a little bit.

She's gonna hit update, that's gonna allow her

to go back and forth.

So we see that wave form

and then you'll notice it's automatically grabbing the VTI

and if you'll look in the upper left hand corner,

it's giving us real time feedback,

real time information based on this patient at this moment.

So she's gonna hit freeze

and the system is actually going

to auto measure five different measurements,

five different waveforms.

One of my favorite things about this calculation is instead

of just saying this is the information

that you need,

I think we lost our screen.

Laura, if you can rein,

- We lost Kim completely so - Hopefully

- Come back in.

- Did - Yeah,

- Let - Me, you wanna text her?

- I sure do. - Okay, great.

Hold tie it everyone, we will get everything

back in just a moment.

- So I, I'm gonna keep just speaking through it while wait

for Kim to come on

because you were able to see that as we had

that live trace of the waveform, SOCY PX was giving us

that live real time feedback up in up on the

imaging monitor in the upper left hand corner.

And so I was able to see automatically

what the patient's cardiac output stroke volume

VTI was in that moment.

And then as soon as we hit freeze,

it actually auto auto measured five different wave forms.

Now this is where, what I was saying my favorite part of

of the measurement is in this moment is that instead

of just giving you the result

and saying here's what we, here's

what the automation measurement is,

we're actually giving you the individual components

and I kind of equate it to long division if you will.

So on the control panel itself,

and here in a moment once we get Kim back online I'll show

you is we actually show you our work, we're showing you

how we got to that measurement.

And what that allows is it really does allow you

as the clinician to be the clinician to,

to be the physician in the room

and to say, Hey, you know what?

I don't really like that measurement.

I don't like of the five,

I don't really like the third measurement so I don't want

that considered or or to be part of the overall calculation.

So you have the ability to de to delete

that if if you so choose.

It also is great from a teaching perspective

because if you're teaching medical students or residents

or fellows about these specific calculations,

you wanna be able to speak

to them about why is it important.

You know when you have a patient who

has an arrhythmia that you wouldn't wanna consider a beat

that that has the arrhythmia.

So you would want to remove

that from the the calculation.

And so on the control panel itself,

you actually have the ability to confirm each one

of those individual measurements and then you hit save.

And now that is part of the record.

Now if you are looking at it from a pre

and a post fluid challenge perspective,

what you would do is you would do your fluid challenge,

whether that's doing a passive leg raise

or whether it is giving fluids.

You would wait the allotted time

and then you would go back in

and you would do those post measurements.

So you same process you, you don't have

to repeat the LVOT diameter

because that is a constant,

you would just repeat the doppler of the LVOT.

So you would get those new wave forms,

you would activate the calculation this time instead

of selecting pre, you would select post

and then you would get those measurements again,

the system automatically grabs those

measurements one at a time.

You hit freeze, it gives you all five of those measurements.

And this is where again, you have the ability

to see the work, you confirm the measurements that you want,

the waveforms that you want.

And this is where the system I I mentioned

that it gives you multiple layers of information as soon

as you save those post measurements, it is actually going

to give you the percent change as it relates to,

to cardiac output.

The percent change as it relates

to there she is, she's back.

It's gonna give you, I'm so sorry. No, no worries.

The the percent change of the cardiac output.

So I'm gonna stop there.

We're gonna get caught up to where I was.

So what you see here is that the,

let's see, waveforms have been done

and she has confirmed those

and I just wanna make sure, Kim, that you hit save.

Perfect. Then this is where like I was explaining,

you're gonna give your fluid challenge

and then you're going to repeat that measurement.

So Kim, go ahead and unfreeze,

I do apologize, the image is a little blurry so I'm not sure

what exactly is going on,

but I do believe that you'll be able to see

what it is that we're talking about.

So she's gonna rege get these measurements

from a post perspective.

So she's gonna go back into that calc package.

- Some technical difficulties here, aud,

I'm gonna try uns spotlighting

and re-spot lighting to see if it helps. Can you?

- Okay, perfect.

- There we go. That's better, right?

- Yes, that is much better. Thank you.

Perfect. I think her daughter got a little nervous

with the power surge

or you can tell

that the heart rate is elevated just a little bit more in

comparison to when we started.

So go ahead and just hit that doppler,

we're gonna get those wave forms, take

that gain down just a little bit, Kim.

So we're gonna go back into the calc package.

She's gonna select post, go ahead and select post.

There we go. It's gonna auto trace

and then we're gonna hit freeze.

I know our image right now is moving

around just a little

bit, right?

It wouldn't be accurate if we didn't

show you what it's really like.

Go ahead and freeze that Kim and then send me back.

There we go. So you can see that's not a perfect, I,

I actually like this because you guys know that

in a clinical setting it's never going to be perfect.

You're gonna have patients who are moving,

you're gonna have patients who are supine difficult studies.

So you can even see from this th those are not perfect

waveforms, but the software,

the technology built into PX does have the ability to say,

you know what, I'm gonna choose the best measurements,

the best waveform that that I can, I'm gonna trace those.

So even those, those are not perfect waveforms.

It do, it wa it did have the ability

to accurately trace the ones that that we had.

So here you have the ability to then go the,

as I was explaining on the control panel off

to the right hand side, it does show you that area of

what I was talking about the long division to

where you can confirm the measurements.

So Kim's gonna go ahead and confirm those.

You'll see that it's gonna change from a dotted line

to a solid line on the interface.

And then she's gonna hit save.

And this is where I was talking about that multi-layer

of of information.

Now obviously this data is not accurate.

We did not perform a fluid challenge

on Kim's daughter today.

But you can see this is the information that we're able

to provide you really with one calculation giving you

that percent change as far as cardiac output goes,

the stroke volume as well as the post VTI variation change.

And so that's all information that is clinically relevant

to you so

that you can better assess your patient's fluid

responsiveness and you can know with confidence whether

or not you need to be withholding fluids

or giving your patients fluids.

Now like I said earlier, Kim, go ahead and go back to 2D

and just go back into that calc, the home calc package

for focused cardiac.

I did just wanna mention now my preference is

the assisted cardiac output

because like I said, it gives you a lot of information

with one calculation.

But we do have other ways to evaluate volume status on px.

And so if you'll just go ahead

and go into volume status, you'll see

that we have the ability to look at pre

and post VTI, which again we already do.

If you're doing the assisted cardiac output,

if you wanna look at IBC collapsibility, you can do that.

And I just wanna point out that these options here, the pre

and post VTI as well as IVC collapsibility, those are all

for spontaneously breathing patients.

But if you have a mechanically ventilated patient,

then you would wanna select respiratory variation.

And these measurements are specifically for those patients

who are mechanically ventilated.

So that is just an overview of really

how socy PX can really help streamline your process,

take away some of the complexity

that you might experience from performing a traditional

cardiac output and give you that those multiple layers

of information that you need

to better evaluate your patient.

If you have any que any questions, please go ahead

and type those into the Q and A box

and we would be happy to get to those.

Like I said, if at any point you would love, you would like

for us to come in and you would like to to scan

with the system, we're more than happy to do that.

And then obviously with some COVID restrictions in place,

if you aren't allowing vendors into your facility right now,

we certainly understand that

and we do have different options to be able to be able

to fully demonstrate the product

to you in the virtual platform.

- Hey Audra, I do have one question.

- Okay, - What if I only wanna evaluate my patient's

cardiac output without looking at fluid responsiveness?

- Great question.

So yeah, so Kim, go ahead and go back to focused cardiac.

So within assisted cardiac output, go ahead

and just select that for me.

You do not have to perform

that post measurement if you only wanted to see

what is my patient's cardiac output right

here, right now.

You can do that and you can do that just

with the prem measurement.

So you do not have to do a fluid challenge if that's not

what you're looking for to be,

to be looking at fluid responsiveness, you can still utilize

this, this new measurement

and the enhanced features of, of it helping you

trace those waveforms and giving you the real time feedback.

You would just do it underneath

that pre measurement. Great question.

- Got it. Thank you. - Absolutely.

So I wanted to just say thank you to Kim.

Thank you to Kim's daughter for allowing us to scan her.

Thank you for your patience today.

I know that we encountered some technical difficulties

with some power surges, so thank you

so much for your patience.

Thank you for joining us today.

I hope you each have a wonderful evening. Thanks so much.

- Thank you.

Join our expert for a live demonstration of the new Assisted Cardiac Output (ACO), an innovative new feature of Sonosite PX point-of-care ultrasound system. Learn more about the advantages of using ACO to evaluate your patients more quickly by removing steps and complexity from the manual CO workflow.

What You'll Learn

  • Learn how using ACO in conjunction with volume status calculations will streamline your evaluations of patients’ fluid responsiveness
  • Tips for measuring Left Ventricular Outflow Tract Diameter (LVOTd) prior to utilizing ACO
  • Discover how to use ACO with live or frozen images
Audra Upton
Presenter: Audra Upton, BS, RDCS, RVT
Position: Director, Clinical Applications, Fujifilm Sonosite

Audra Upton is the Director of the Clinical Applications team with more than 13 years of experience with Fujifilm Sonosite. She graduated from the University of Oklahoma with a degree in ultrasound and is a registered cardiac and vascular sonographer. Audra and her team remain customer-focused and are specialized in providing top-level point-of-care ultrasound education.

Related

This educational webinar is intended for healthcare professionals and not for patients or consumers. The material is provided for general educational purposes, as a reference and a supplement to professional experience, education and training, and should not be considered the exclusive source for this type of information. This educational webinar is not intended to recommend any device for a particular indication or to provide indications for use for any device. At all times, it is the professional responsibility of the practitioner to exercise independent clinical judgment in each particular situation. Fujifilm assumes no responsibility or liability for any misuse of the information imparted in this webinar. This educational webinar does not supplement, replace, or supersede device labeling, including instructions for use, which accompanies any FUJIFILM Sonosite product.