title: International evidence-based recommendations for focused cardiac ultrasound.
abstract: BACKGROUND
  Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use.
  
  
  METHODS
  The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method.
  
  
  RESULTS
  During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients.
  
  
  CONCLUSIONS
  This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
authors.affiliation: Servizio di Anestesia e Rianimazione 1, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy. Electronic address: gabriele.via@winfocus.org.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Via
authors.affiliation: Cardiac Critical Care, King Abdulaziz Medical City, Ministry of National Guard Health, Riyadh, Saudi Arabia.
authors.forename: Arif
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authors.affiliation: Division of Emergency Medicine, University of the Witwatersrand, Netcare Union Hospital Emergency Department, Johannesburg, South Africa.
authors.forename: Mike
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authors.lastname: Wells
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Robert
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authors.lastname: Reardon
authors.affiliation: National & Gulf Center for Evidence Based Health Practice, King Saud University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
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authors.lastname: ElBarbary
authors.affiliation: Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
authors.affiliation: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York; Department of Pediatrics, Mount Sinai School of Medicine, New York, New York.
authors.forename: James W
authors.initials: JW
authors.lastname: Tsung
authors.affiliation: University Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Aleksandar N
authors.initials: AN
authors.lastname: Neskovic
authors.affiliation: Adult Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Susanna
authors.initials: S
authors.lastname: Price
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Achikam
authors.initials: A
authors.lastname: Oren-Grinberg
authors.affiliation: Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Andrew
authors.initials: A
authors.lastname: Liteplo
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cordioli
authors.affiliation: Pediatric Cardiology, Royal Brompton Hospital, London, United Kingdom.
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authors.lastname: Naqvi
authors.affiliation: Intensive Care, Santa Cabrini Hospital, Montreal, Quebec, Canada.
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authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Acute and Chronic Pain Therapy, University Hospital, Brussels, Belgium.
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authors.lastname: Poelaert
authors.affiliation: Department of Cardiosurgery, University Clinical Center of Maribor, Maribor, Slovenia.
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authors.initials: TG
authors.lastname: Guliĉ
authors.affiliation: Department of Anaesthesia & Intensive Care, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Erik
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authors.lastname: Sloth
authors.affiliation: Department of Cardiovascular Sciences, University of South Florida, Tampa, Florida.
authors.forename: Arthur
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authors.lastname: Labovitz
authors.affiliation: Department of Medical Education, Scripps Mercy Hospital, San Diego, California.
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authors.lastname: Kimura
authors.affiliation: Emergency Department, Hospital of the City of Frankfurt, Frankfurt am Main, Germany.
authors.forename: Raoul
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authors.lastname: Breitkreutz
authors.affiliation: Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
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authors.affiliation: Emergency Medicine, Sydney Adventist Hospital, Sidney, Australia.
authors.forename: Justin
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authors.lastname: Bowra
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel
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authors.lastname: Talmor
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Cardiothoracic Anaesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy.
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authors.initials: F
authors.lastname: Guarracino
authors.affiliation: Emergency Department, Fremantle, Australia.
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authors.lastname: Goudie
authors.affiliation: Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Wang
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authors.lastname: Xiaoting
authors.affiliation: Respiratory & Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chawla
authors.affiliation: Laboratory of Echocardiography, Cardio-Angiology with CCU, Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.affiliation: Department of Emergency Medicine, University of South Carolina School of Medicine, St Francis Hospital, Columbus, Georgia.
authors.forename: Micheal
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authors.lastname: Blaivas
authors.affiliation: Samu 93, University Hospital Avicenne, Bobigny, France.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Petrovic
authors.affiliation: Intensive Care Unit "G. Bozza," Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Storti
authors.affiliation: AREU EMS Public Regional Company, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Neri
authors.affiliation: Department of Emergency Medicine, New York Methodist Hospital, Weill Medical College of Cornell University, New York, New York; Clinical Epidemiology Unit, Division of General Internal Medicine, Department of Medicine, Weill Medical College of Cornell University, New York, New York.
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mesh_terms: D032921:Consensus; D003245:Consensus Statements as Topic; D004452:Echocardiography / Q000592:standards*; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D019095:Point-of-Care Systems / Q000592:standards*; D017410:Practice Guidelines as Topic
keywords: Cardiac sonography; Cardiac ultrasound; Crit Care echocardiography; Critical ultrasound; Echocardiography; Emergency ultrasound; Evidence-based medicine; GRADE; Guideline; Point-of-care ultrasound; RAND