Abstract
INTRODUCTION: Over the last few decades, significant advancements have been made in the adoption of point of care ultrasound (POCUS) in intensive care for procedural and diagnostic purposes. There is limited information on the relative adoption and usage of POCUS between high and low/middle-income countries. OBJECTIVES: To compare the relative use of POCUS for procedural and various diagnostic purposes based on the type of economy (High Income [HI] and Low and Middle Income [LMI]). MATERIALS AND METHODS: Data was obtained from an international Critical care Ultrasound Penetration (CUSP)survey. The CUSP survey instrument was designed and validated by an international group of intensivists and advanced practice providers and was distributed through the Society of Critical Care Medicine listserv in May/June 2024. Both random and snowball sampling methods were utilized. The target population was all critical care practitioners worldwide, with the survey population predominantly consisting of Society of Critical Care Medicine members. Countries were categorized as HI and LMI based on the World Bank classification. The respondents were asked to quantify their use of POCUS in eligible patients in the last year(never, rarely [<25%], sometimes [26-50%], often [51-75%], and almost always [>75%]).The responses were recategorized as standard use(almost always) versus inconsistent/non-usage (other responses) for analysis. Two-group[HI vs. LMI] analysis of categorical responses was conducted using the Chi-square test. RESULTS: A total of 503 responses were obtained from 39 countries. Of these, 390 (77.6%) respondents were from 21 HI countries, while 112(22.3%) were from 18 LMI countries. Respondents from LMI countries were more likely to be adult practitioners (104/112,92.8% vs. 293/390, 75.1%, p<0.001) and were more likely to be physicians (107/112, 95.5% vs. 302/389, 77.6%, p<0.001). There was no difference between the two groups in the proportion of respondents with additional training or certification in POCUS. Respondents from HI countries were more likely to use POCUS for vascular access, such as internal jugular central line (95.6% vs. 63.9%, p<0.001), arterial line (61.6% vs. 32.3%, p<0.001), and peripheral IV (28.8% vs. 6.7%, p<0.01). Although POCUS was more commonly utilized for femoral central line placement in LMI countries (40.4% vs. 18.4%, p<0.01), POCUS was also more often utilized as standard in LMI countries for procedural uses such as pericardiocentesis (26%vs.18.8%, p=0.002), paracentesis (67.8% vs.54.6%, p=0.012), and tracheostomy (49.1% vs. 21.6%, p < 0.001). The use of POCUS was also more standard in qualified patients for various diagnostic purposes in LMI countries, such as assessment of qualitative left ventricular function(54.2% vs.37.3%, p=0.001), valvular dysfunction (32.6% vs.16.2%, p<0.01), advanced filling pressure(34.1% vs.10.9%, p<0.001), interstitial and parenchymal lung pathology (40.9% vs.17.8%, p<0.001), ascites assessment in non-trauma settings (48.6% vs.28%, p<0.01), intracranial pressure by optic nerve sheath diameter (26% vs.4.3%, p<0.01), and deep vein thrombosis assessment (36.3%vs 10.6%, p<0.001). The significantly higher utilization of POCUS for most diagnostic indications in LMI countries persisted even after excluding pediatric providers.(–) CONCLUSIONS: Among the respondents of the CUSP survey, POCUS was more commonly used as the standard of care for vascular access procedures in HI countries and for diagnostic purposes in LMI countries. While the responses may be biased towards practitioners with access to ultrasound equipment, this analysis still shows high enthusiasm for POCUS in LMI countries. GRANT ACKNOWLEDGMENT (IF ANY): Children's Hospital of Illinois Foundation Grant 3000$ for dissemination of the survey through the Society of Critical Care Medicine listserv (Sandeep Tripathi). Other than providing the funds (Children's Hospital Foundation) and distributing the survey (SCCM), they had no involvement in the design, analysis, or interpretation of the survey results.