Objective: To investigate the clinical application value of emergency bedside-echocardiology (EB-Echo) examination. Objective and methods: To retrospectively analyze the data of 250 patients who underwent EB-Echo examination in our hospital from 2007 to 2009, including 136 males and 117 females, aged 1 h to 17 years after birth, with a mean age of 2.34±1.28 years, and to apply Philips IE-33 echocardiograph and Sonosite Micromax portable ultrasound instrument for bedside cardiac Ultrasound was performed with a Philips IE-33 echocardiograph and a Sonosite Micromax portable ultrasound machine. The positive rate was 62.8%. The children with congenital heart malformation and persistent pulmonary hypertension were the most affected children. Conclusion EB-Echo examination, as an extension of the application of conventional echocardiography, can provide timely information on the presence or absence of abnormalities in intracardiac structures, and can evaluate the systolic and diastolic functions of the heart and make a clear diagnosis. Emergency bedside-echocardiology (EB-Echo) has developed into an imaging tool that is very dependent on clinical diagnosis and treatment in pediatric critically ill patients. Pediatric patients, especially infants and newborns, have a high rate of complex congenital heart disease and have rapidly changing conditions with atypical signs and symptoms. Therefore, EB-Echo has received increasing attention from clinical pediatricians. The purpose of this study is to explore the value of EB-Echo in the clinical application of pediatric intensive care unit (ICU) by summarizing and analyzing the results of EB-Echo application. 1 , Data and methods 1.1 General data From 2007 to 2009, there were 250 cases of children hospitalized in our ICU who underwent EB-Echo examination, 136 males and 117 females, aged from 1 h to 17 years after birth, with an average age of 2.34±1.28 years, all of whom were critically ill or unable to move with tracheal intubation and ventilator-assisted treatment. 1.2 Methods A Philips IE-33 echocardiograph and a Sonosite Micromax portable echocardiograph were used for bedside cardiac ultrasound exploration, respectively. The children were placed in the supine position, and the long axis of the left ventricle, short axis of the aorta, apical four chambers, subxiphoid four chambers, subxiphoid double chambers, long axis of the aortic arch of the superior sternal fossa, and short axis of the aortic arch of the superior sternal fossa were scanned to observe two-dimensional and color Doppler flow, and left ventricular systolic function was also measured. Once the Sonosite Micromax portable ultrasound was adequate for diagnosis, further exploration was performed with IE-33. 2. Results 2.1 Diagnostic results Among all children with cardiac ultrasound examination, 157 cases of abnormalities were found, 93 cases of no abnormalities were seen, and the positive rate was 62.8%; the specific classification of patients with central ultrasound abnormalities is shown in Table 1. A total of 58 children with congenital cardiac anomalies were first detected in two dimensions by Sonosite Micromax portable ultrasound, followed by precise measurement by IE-33. In 78 neonates with persistent pulmonary hypertension, the ultrasound showed right atrial and right ventricular dilatation with left-to-right, bidirectional or right-to-left shunts from the foramen ovale at the atrial level, and left-to-right, bidirectional or right-to-left shunts from the ductus arteriosus with a diameter of 2 to 4 mm, and regurgitant flow from the tricuspid orifice during systole. Among the 8 cases of cardiomyopathy, 5 cases of dilated cardiomyopathy were found to have spherical dilatation of the left ventricle with reduced wall motion, darker flow in each valve, and significantly decreased short-axis shortening (FS); 3 cases of hypertrophic cardiomyopathy were found to have significant septal thickening with a ratio of more than 1.4 to the posterior wall of the left ventricle on ultrasound. 2 cases of ventricular tachycardia and 8 cases of supraventricular tachycardia were found among the 10 cases of rhythm disturbances. Ultrasound examination revealed significant enlargement of the heart in 3 cases, decreased amplitude of ventricular wall motion, and decreased FS and ejection fraction (EF). 2.2 Treatment and prognosis Among 250 children with EB-Echo examination, 235 were discharged after treatment with an efficiency of 94%; 8 died and 7 were discharged automatically. Among the 58 children with precordial disease, 16 cases of complex cardiac malformations, including 4 cases of complete pulmonary venous malformation drainage, 3 cases of supracardiac type and 1 case of intracardiac type, underwent surgery for radical treatment; 2 cases of transposition of the great arteries did not undergo other tests, and were discharged after direct Switch surgery; this reflects the value of EB-Echo. 78 cases of persistent pulmonary hypertension in neonates were diagnosed clearly by ultrasound and treated with tolazurin or One case of massive pericardial effusion with pericardial tamponade was immediately aspirated by bedside ultrasound localization, and the child’s dyspnea and tamponade symptoms were relieved immediately after aspiration. EB-Echo examination, as an extension of conventional echocardiography, started in the early 1980s. It can provide a timely understanding of the abnormalities of the internal structures of the heart and evaluate the systolic and diastolic functions of the heart, so that a clear diagnosis can be made in a timely manner for children in critical condition who cannot be moved, providing a reliable basis for further examination and treatment. Currently, EB-Echo examination is convenient, flexible, accurate, and fast to obtain information on cardiac structure and function without interfering with the resuscitation process and providing immediate clinical guidance for patient management and prognosis, and is generally respected by clinicians in the management of cardiac emergencies. In this paper, after retrospectively analyzing the application of EB-Echo in our hospital, we found that the value of EB-Echo is mainly reflected in the following aspects: (1), timely diagnosis of complex precardiac disease, providing clues for early treatment. In children with cyanotic precocious heart disease such as transposition of the great arteries, the opening of the arterial catheter is of great importance to maintain the oxygen of the child, and once it is closed, the life of the child is greatly threatened; the application of EB-Echo timely avoids the closing of the arterial catheter caused by clinical medical oxygen therapy, and saves the life of this type of children. (2) Early detection of persistent pulmonary hypertension in neonates greatly improves the success rate of neonatal pulmonary disease; at the same time, it can dynamically detect changes in pulmonary artery pressure and guide clinical use of drugs. (3), pericardial tamponade is difficult to distinguish from constrictive pericarditis and restrictive cardiomyopathy in terms of symptoms and signs, while a large amount of pericardial fluid causing tamponade requires immediate puncture and drainage. Therefore, it is very important to make a clear diagnosis as soon as possible. For the diagnosis of massive pericardial effusion, ultrasound is the preferred means of examination and can guide the puncture and observe the amount of residual effusion. (4), The treatment principles of hypovolemic shock and cardiogenic shock are very different, and it is sometimes difficult to distinguish between the two types of shock in pediatric patients, and EB-Echo observation of cardiac enlargement, myocardial pulsation, and ventricular systolic function is very helpful for differential diagnosis. The present results show that EB-Echo is an expansion of the clinician’s physical examination, and its diagnostic and monitoring characteristics go hand in hand, and its value for resuscitation of critically ill patients is becoming increasingly apparent. At the same time, cardiac malformations and neonatal pulmonary hypertension occupy the vast majority of pediatric critical illnesses, unlike the predominance of coronary artery disease in adults, which requires higher operator experience and instrumentation for pediatric EB-Echo. Comprehensive literature reports that the positive rate of EB-Echo in China ranges from 84.1% to 100% [4], and the positive rate in our group of cases is 62.8%, which may be a characteristic that the disease spectrum of children is different from that of adults. The efficiency rate of children who underwent EB-Echo examination was also 94%, suggesting the possible clinical emergency value of EB-Echo, which plays a role in guiding clinical treatment that cannot be replaced by other imaging examinations. EB-Echo’s Sonosite Micromax portable echocardiography pulse and continuous Doppler examinations have a significantly higher probability of underestimation than traditional transthoracic cardiac ultrasound IE-33 because of the larger sampling frame; semi-quantitative diagnosis and more accurate measurement of left ventricular ejection fraction by the apical four-chamber heart simpson method still need to be completed by IE-33. Therefore, when the results of portable echocardiography are not completely certain, the final diagnosis still needs to be confirmed by IE-33; while for complex cardiac malformations, Sonosite Micromax portable echocardiography mainly plays a screening role, and IE-33 is needed to confirm the diagnosis. Although EB-Echo is limited by instrumentation and environmental factors, it is difficult to achieve detailed accuracy, but experienced ultrasonographers can still make Although EB-Echo is limited by the limitations of the instrumentation and environmental factors, experienced ultrasonographers can still make a more accurate preliminary diagnosis, which is of great significance for further examination and treatment, and should be emphasized in pediatric clinics.