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Diplomatosis

Focus assessed transthoracic echocardiography (FATE)

Authors: Tim Astles 

Publication date:  16 Jul 2011


Who is it for?

The course is aimed at any doctor involved in the care of critically ill patients, whether in the intensive care unit, operating theatre, emergency department, or other area. All the candidates on the 2010 course were anaesthetists, but the course is also suitable for emergency or acute medicine physicians or intensivists.

When did you do it?

I was a specialty trainee year 4 in anaesthesia when I went on the course; the other participants were fellow registrars or consultants.

Why did you do it?

I was keen to start learning how to use echocardiography to assess the critically ill patient. This course was aimed at people with little or no previous skill in echocardiography; and as well as covering the basic foundations of echocardiography it quickly allowed me to gain the skills needed to use echocardiography to assess real patients, initially with supervision. Although my assessment would be nowhere near as detailed as that performed by a cardiologist or echocardiography technician, it would nevertheless allow me to identify major pathology and guide treatment.

How much effort did it entail?

We were provided with an article about the focus assessed transthoracic echocardiography (FATE) protocol before coming on the course. The article explained some of the background behind the FATE examination and allowed us to gain some basic knowledge about the relevant cardiac anatomy and familiarise ourselves with some of the terminology. I found this pre-course reading useful, as I had no prior experience of echocardiography; and having read this literature I felt that at least I wasn’t starting the course with zero knowledge.

Was there an exam?

There was an informal multiple choice question test at the end of the course and a practical assessment in which we had to demonstrate that we were able to obtain the main views of the heart and pleura.

What did the course entail, and how much did it cost?

The FATE course was held over two days at the Liverpool Heart and Chest Hospital. The programme consisted of short lectures covering the basic anatomy and physics of echocardiography; “knobology”; the views needed for the FATE protocol; how echocardiography can be used in the management of the critically ill patient; and some of the common pitfalls of echocardiography.

The lectures were given by cardiologists, cardiac anaesthetists, and radiologists. A number were delivered by Erik Sloth, a Danish anaesthetist and intensivist who pioneered the FATE protocol and has published and lectured extensively on the subject.

The remainder of the course (at least half) was spent in practical workshops getting hands-on experience of performing echocardiography on volunteers. These sessions were run in groups of four candidates—each group having an echo machine, a volunteer on which to perform the scans, and an echocardiography technician to help show us where we were going wrong and how to get the best images.

By the end of the course everyone was becoming adept at obtaining the views necessary to perform a FATE protocol examination.

The course cost £320, included a cooked lunch and refreshments on both days, and is approved for 10 continuing professional development points.

Top tips

  • Read the provided literature beforehand to make sure you get the most out of the busy two days on the course.

  • After completing the course, make sure that you continue to perform FATE assessments as often as you can, with an experienced supervisor when at all possible, to ensure that your technique and proficiency continue to improve.

Further information

The FATE course is run annually at Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE. The course director is Dr T Ridgeway. More information on the FATE protocol itself is at www.fate-protocol.com.

Was it worth it?

The course was definitely worthwhile. It provided me with a solid introduction to echocardiography and allowed me to begin performing echocardiography assessments as part of my clinical practice. Although I am still learning, the course allowed me to begin to use echocardiography to gain additional information about critically ill patients under my care and interpret these findings in the clinical context. As I continue to gain more experience I envisage echocardiography playing an increasingly important role in guiding and optimising treatment of the critically ill patient.

Competing interests: None declared.

Tim Astles specialty registrar in anaesthesia Department of Intensive Care Medicine, University Hospital Aintree, Liverpool, UK

 timastles@nhs.net

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