The use of ultrasound to look for lung pathology started in the early 1990’s to look for pneumothorax and it’s evolution since then has increased dramatically. We can now use lung ultrasound to look for interstitial edema, pleural effusions, empyemas, pneumonias, etc. In addition we have been using Point of Care Ultrasound for cardiac evaluation as well.
So it seems intuitive that we should also be using Point of Care Ultrasound to evaluate COVID-19 (Coronavirus) patients to limit or eliminate the number of chest X-rays, CT scans, and formal echos that are ordered. But what’s the evidence for this?
Lingering Questions About POCUS and COVID-19:
- How long does the COVID-19 (Coronavirus) affect the lung? As an EM doc and intensivist, I would sure like to know how long I should expect my patient’s symptoms to peak and resolve. (check out how lung ultrasound findings on a COVID-19 patient continued despite symptoms resolution)
- How does COVID-19 affect the heart? There is growing evidence on this as well (link to articles below in table) and also for up to date information on CARDIAC complications of COVID-19 using ultrasound. Find the compiled CARDIAC/COVID-19 Twitter cases and discussion HERE as well as Twitter POCUS/COVID-19 registry HERE.
- How many ultrasound points on the lung should we be scanning? Some experts say we should do just 6-8 points and others say 12-14 points. I normally do just a 6-point exam for other disease processes, but my opinion is that we should do 12-points given the multifocal nature of the COVID-19 disease process.
- What is the best way to decontaminate ultrasound machines?
- Should we be using cart-based systems or hand-helds?
- Should we be performing Point of Care Ultrasounds on ALL COVID-19 suspected/confirmed patients or just patients with abnormal vital signs given how contagious and virulent SARS-CoV-2 is to healthcare professionals? It would be interesting to see what the “Number Needed to Scan” would be on COVID-19 patients with normal vital signs to change management and affect outcome versus what the “Number Needed to Scan” on stable COVID-19 patients to infect a healthcare professional who then spreads it to other staff and patients? Overall, my stance is to limit lung ultrasound to COVID-19 suspected/confirmed patients that have abnormal vital signs. I think the risk of COVID-19 exposure outweighs the benefits in this subgroup of patients. However, others may not agree with me and advocate Point of Care ultrasound for every single COVID-19 suspected patients. That’s okay, everyone is entitled to their practice style and why a post like this may help you find yours. FYI, most societies are advocating a more conservative approach.
Debate Among POCUS Experts
Yes, many of these questions remain unanswered and there is still lots of debate amongst the POCUS community even on the number of lung points/zones to scan. Look at the poll below by Resa Lewis (past ACEP Ultrasound Section Chair):
Here is another twitter reply (see below) to one of my posts that advocates for liberal lung ultrasound in all patients:
But there are other experts (and myself) who have a more conservative approach to lung ultrasound:
Yes, the debate continues….. and I don’t have all the answers..
Let’s Learn From Evidence Across the Globe!
My goal in this post is not to persuade you what to do, it’s to just help provide easy access to evidence that’s currently out there regarding using ultrasound in COVID-19. I hope this can help you decide how to tailor your own practice based on the global experience of others. The authors of these studies come from different areas of the world and describe what has worked best in their universal fight against COVID-19
This post lists the current literature/evidence on using Point of Care Ultrasound in COVID-19 (Coronavirus) with article name, country, and author. Just click on the title to go to the article source. Also, the table below is sortable. *These resources are specific to Point of Care Ultrasound and do not include articles on CT and Xray findings.
I will try my best to update the list as more articles come in. Feel free to comment below or contact me if there are more updated articles that I should include! I’m a busy clinician as well, so apologies if not updated immediately when something comes out. Thanks and stay safe.
Table for Registry of Evidence for POCUS in COVID-19
|Article Title||First Author||Country||Publication Date (Year.Month)||Publication Type|
|ASE Statement on Point-of-Care Ultrasound (POCUS) During the 2019 Novel Coronavirus Pandemic||Johri||Multidisciplinary||2020.04||ASE Expert Consensus||https://www.asecho.org/wp-content/uploads/2020/04/POCUS-COVID_FINAL2_web.pdf|
|Just the Facts: Recommendations on Point of Care Ultrasound Use and Machine Infection Control During the COVID-19 Pandemic.||Kim||Canada||2020.04||Editorial||https://www.ncbi.nlm.nih.gov/pubmed/32268930|
|Our Italian Experience Using Lung Ultrasound for Identification, Grading and Serial Follow‐up of Severity of Lung Involvement for Management of Patients with COVID‐19||Vetrugno/Lichtenstein||Italy||2020.04||Editorial||https://onlinelibrary.wiley.com/doi/10.1111/echo.14664|
|Canadian Internal Medicine Ultrasound (CIMUS) Recommendations Regarding Internal Medicine Point-of-Care Ultrasound (POCUS) use during Coronavirus (COVID-19) Pandemic||Ma||Canada||2020.04||Editorial||https://cjgim.ca/index.php/csim/article/view/438|
|Lung ultrasound findings in a 64-year-old woman with COVID-19||Thomas||Canada||2020.04||Case Report||https://www.cmaj.ca/content/early/2020/03/31/cmaj.200414.long|
|Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19||Hua||United Kingdom||2020.03||Case Report||https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa253/5813280|
|Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)||Inciardi||Italy||2020.03||Case Report||https://jamanetwork.com/journals/jamacardiology/fullarticle/2763843|
|Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin||Hongde||China||2020.03||Case Report||https://www.ncbi.nlm.nih.gov/pubmed/32176300|
|Proposal for international standardization of the use of lung ultrasound for COVID-19 patients; a simple, quantitative, reproducible method||Soldati||Italy||2020.03||Editorial||https://onlinelibrary.wiley.com/doi/epdf/10.1002/jum.15285|
|Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak.||Buonsenso||Italy||2020.03||Case Report||https://www.ncbi.nlm.nih.gov/pubmed/32196627|
|Is there a role for lung ultrasound during the COVID-19 pandemic?||Soldati||Italy||2020.03||Editorial||https://www.ncbi.nlm.nih.gov/pubmed/32198775|
|COVID-19 outbreak: less stethoscope, more ultrasound.||Buonsenso||Italy||2020.03||Editorial||https://www.ncbi.nlm.nih.gov/pubmed/32203708|
|How to perform lung ultrasound in pregnant women with suspected COVID-19 infection.||Lazone||Italy||2020.03||Editorial||https://www.ncbi.nlm.nih.gov/pubmed/32207208|
|A preliminary study on the ultrasonic manifestations of peripulmonary lesions of non-critical novel coronavirus pneumonia (COVID-19)||Huang||China||2020.03||Observational||https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3544750|
|Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic.||Peng||China||2020.02||Case Series||https://www.ncbi.nlm.nih.gov/pubmed/32166346|