Evidence & Independent Review
Published performance stated exactly as studied, cited inline — alongside what independent reviewers said about it, and the limitations they raised.
Published studies
Bughrara N, Renew JR, Alabre K, et al. Comparison of qualitative information obtained with the echocardiographic assessment using subcostal-only view and focused transthoracic echocardiography examinations. Can J Anaesth 2022;69(2):196–204.
doi:10.1007/s12630-021-02152-6Fiorini K, Basmaji J. Point-of-care ultrasound in the management of shock: what is the optimal prescription? Can J Anaesth 2022;69(2):187–191.
doi:10.1007/s12630-021-02151-7Sanfilippo F, La Via L, Flower L, Madhivathanan P, Astuto M. The value of subcostal echocardiographic assessment, and directions for future research. Can J Anaesth 2022.
doi:10.1007/s12630-022-02225-0Bughrara N, Neilson MR, Jones S, et al. Is 1 day of focused training in echocardiographic assessment using subxiphoid-only (EASy) examination enough? Crit Care Explor 2024;6(3):e1038.
doi:10.1097/CCE.0000000000001038
Independent Commentary
Two independent groups assessed the published EASy work in Can J Anaesth. These are their voices, not ours.
The editorialists commend the work for refining “the minimum competency standards of the operator” and the scope of point-of-care ultrasound that still yields clinically valuable information — while reducing the time the scan takes.
An independent group from Catania, London, and Cambridge judged the study capable of laying the foundations for a shift in basic critical care echocardiography training, and suggested “EASY will become the first approach novices learn.”
Performance
Fast enough to repeat
Average examination time, novice sonographers
Protocols that take less time are more likely to be repeated when the patient changes.
Fiorini & Basmaji, Can J Anaesth 2022;69(2):187–191
Compared against focused transthoracic echocardiography using parasternal, apical, and subcostal windows, subcostal-only assessment showed almost perfect agreement for pericardial effusion (Gwet's AC1 0.98), interventricular septal motion (0.92), and RV contractility (0.84), and substantial agreement for RV size (0.70), LV size (0.73), and LV contractility (0.73). (Can J Anaesth 2022)
Limitations
The window fails in a meaningful minority. The comparison study analyzed 82 of 102 patients — those with usable subcostal views. The editorialists note that up to 20% of scans were poor quality and not interpretable, which they say may overestimate the benefit of the assessment, and conclude that this view cannot be relied on alone for a significant number of patients.
The conclusion is conditional. When subcostal images could be obtained, the qualitative information was sufficiently accurate compared with full focused transthoracic echocardiography.
Interpretation in that study was performed by experts, who may require fewer data points than novices to act — which is why the EASy pathway keeps interpretation supervised.
Agreement was measured in aggregate. Gwet's coefficient does not show whether disagreements clustered on ruling pathology in or ruling it out.
EASy is not an accreditation pathway. Independent commentary states that in isolation it is unlikely to be sufficient for accreditation in critical care echocardiography.
Future validation
Both commentaries call for external validation, and one recommends full adherence to the PRICES reporting standard for critical care echocardiography research. Prospective multicentre evaluation is the next step, and EASy's development follows that roadmap.
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