EP175 Audit of a cardiac point-of-care ultrasound (POCUS) protocol for patients with ejection systolic murmur (ESM) or stable heart failure in the pre-operative anaesthesia clinic

<h3>Background and Aims</h3> Pre-operative consultative transthoracic echocardiogram (TTE) is recommended in symptomatic patients with cardiovascular disease, those lacking recent follow-up, or unexplained dyspnea. Current recommendations do not advise for routine TTE for asymptomatic patients with ESM. Studies have shown benefits of cardiac POCUS for planning further investigations and perioperative management. We describe outcomes following application of a pre-operative workflow using cardiac POCUS to reduce the need for TTE and cardiology consults. Ethics approval was obtained for this audit. <h3>Methods</h3> Asymptomatic patients with ESM, patients with known heart failure and limited effort tolerance, or in whom functional capacity was unquantifiable were included. 47 patients were scanned over 22 months by anaesthetists accredited in POCUS. All 4 standard cardiac views, 2D and colour doppler evaluation of the aortic valve and visual estimate of left ventricular ejection fraction were performed. Further cardiac evaluation was arranged for patients with new abnormalities detected. <h3>Results</h3> Our protocol allowed for surgery to proceed without the need for consultative TTE in 23 out of 25 patients with ESM. Two patients had 2D features suggestive of severe aortic stenosis and this was confirmed in one patient following consultative TTE, leading to postponement of surgery. New regional wall motion abnormalities were found in two patients. One patient opted to defer surgery. No patients developed major adverse cardiovascular events. No day-of-surgery cancellations occurred. <h3>Conclusions</h3> Pre-operative anaesthesia clinic cardiac POCUS allows for timely surgical planning and minimises unnecessary cardiology consultations and consultative TTEs. Further research should evaluate its impact on perioperative management and patient outcomes following surgery.