Feasibility and Timeliness of Clinician-Performed Point-of-Care Echocardiography in Suspected Acute Myocardial Infarction: A Prospective Observational Study from Sri Lanka

Background: Acute myocardial infarction requires rapid assessment and treatment. Point-of-care echocardiography (POCE) may provide immediate bedside cardiac information, but its feasibility and timeliness within busy, resource-constrained emergency settings are not well described.Methodology: A prospective descriptive observational study was conducted in the Emergency Treatment Unit of Teaching Hospital, Anuradhapura, from July to August 2023. Adults presenting with symptoms suggestive of acute myocardial infarction were assessed using clinician-performed POCE. The primary outcomes were the feasibility and timeliness of POCE during early emergency assessment. Time from admission to medical assessment, first electrocardiogram, and POCE was recorded. POCE findings, emergency interventions, and agreement in identifying regional wall-motion abnormalities were also assessed.Results: Of the 245 patients who consented, 219 were recruited, and 171 had sufficient data for analysis. The median age was 58 years, and 138 (80.7%) were male. POCE was performed within 5 minutes in 35 (20.5%) patients and within 10 minutes in 86 (50.3%). The corresponding numbers for the first electrocardiogram were 30 (17.5%) and 75 (43.8%), respectively. POCE was performed before the first electrocardiogram in 79 (46.2%) patients and concurrently in 19 (11.1%). Regional wall-motion abnormalities were identified in 125 (73.1%) patients. The sensitivity and specificity of Regional Wall-Motion Abnormalities detected by the medical officer in detecting ST-segment elevation myocardial infarction on the first ECG were 95% and 90%, respectively. Thrombolysis was administered to 74 patients and primary percutaneous coronary intervention to 38. Agreement between the emergency treatment unit medical officer and the emergency physician in identifying regional wall-motion abnormalities was 94.2%, and between the emergency treatment unit medical officer and the cardiologist was 95.9%.Conclusion: Clinician-performed point-of-care echocardiography was feasible and could be performed rapidly during the early assessment of suspected acute myocardial infarction. Regional wall-motion abnormalities identified by trained medical officers showed high sensitivity for ECG-defined ST-segment elevation myocardial infarction and good agreement with expert assessment. POCE may therefore serve as a useful bedside adjunct to electrocardiography in resource-constrained emergency settings.