Lesson 1: What is RACE?
RACE is the acronym of Rapid Assessment by Cardiac Echo, which is a bedside focused transthoracic echocardiography (TTE). Originally, RACE is designed with critical care physicians, however, there is a trend in some countries recently that internal medicine is also picking up the skills and becoming part of their daily practice.
What is RACE?
RACE in short is a TTE study that uses 6 views and 2 modes to answer 4 focused clinical questions:
- What is the left heart function?
- What is the right heart function?
- What is the fluid status? Is the patient fluid responsive?
- Is there any pericardial effusion and echo signs of cardiac tamponade?
RACE are typically used for screening patients who complain of shortness of breath (unexplained), chest pain and for those who are haemodynamically unstable (hypotension and shock). Echocardiography is also recommended for ruling out or confirming cardiac involvement in shock, i.e. cardiogenic shock1. It can also used for differentiating chronic pulmonary hypertension from acute pulmonary hypertension (e.g. due to pulmonary embolism).
How is RACE different from a standard TTE?
RACE differs from a standard TTE in that it aims to complete the bedside procedure quickly (~15 min), and only utilizes 2D-imaging and M-mode in the study. In contrast, a standard TTE utilizes all modality provided and at least incorporate Doppler and tissue Doppler in the study. While RACE focused on the 4 questions, a standard TTE can answer a wide range of questions, e.g. diastolic function, valvular disease and others. As such, a standard TTE may takes 30 to 45 min to complete.
- Cecconi M, DeBacker D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014; 40:1795-1815.