Expecting the unexpected: Echo laboratory preparedness in the time of COVID‐19

Abstract

COVID‐19 poses a unique set of challenges to the healthcare system due to its rapid spread, intensive resource utilization, and relatively high morbidity and mortality. Healthcare workers are at especially high risk of exposure given the viruses spread through close contact. Reported cardiac complications of COVID‐19 include myocarditis, acute coronary syndrome, cardiomyopathy, pericardial effusion, arrhythmia, and shock. Thus, echocardiography is integral in the timely diagnosis and clinical management of COVID‐19 patients. Rush University Medical Center has been at the forefront of the COVID‐19 response in Illinois with high numbers of cases reported in Chicago and surrounding areas. The echocardiography laboratory at Rush University Medical Center (RUMC) proactively took numerous steps to balance the imaging needs of a busy, nearly 700‐bed academic medical center while maintaining safety.

Prognostic utility of quantitative offline 2D‐echocardiography in hospitalized patients with COVID‐19 disease

“…According to international societies, during the COVID‐19 pandemic to reduce the risk of contamination and consumption of personal protective equipment (PPE), examinations were performed only if they provide clinical benefit taking into account patient characteristics, blood test abnormalities, and hemodynamic stability 11–13 …”

“…The operator was required to store basic views (apical chamber views, parasternal long and short‐axis views at the base and mid ventricle, subxiphoid views), color Doppler imaging of the valves, spectral CW Doppler of the tricuspid regurgitant jet. Images were stored in a cine loop in the institutional server and all measurements were performed offline (EchoPAC version 203 GE Vingmed Ultrasound AS) according to current guidelines by an expert operator blinded to the clinical data 12 . Conventional parameters included right ventricular (RV) fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and maximum right atrioventricular trans‐tricuspid gradient 4*(tricuspid regurgitation velocity) 2 .…”

“…According to international societies, during the COVID-19 pandemic to reduce the risk of contamination and consumption of personal protective equipment (PPE), examinations were performed only if they provide clinical benefit taking into account patient characteristics, blood test abnormalities, and hemodynamic stability. [11][12][13] The echocardiograms were performed at the bedside, with patients in the left lateral decubitus position when possible, but mostly in supine or sitting position with a machine dedicated to COVID-19infected patients (Vivid S6 echocardiograph-GE-Medical System, Milwaukee WI). Personnel were provided with adequate PPE.…”

Overview of Current International Recommendations for Echocardiography Exams During the Covid-19 Pandemic and Its Local Implementation in Austria

“…Teaching or device training should not take place when examining patients with Covid-19. Authors also recommend to use limited echocardiography protocols focusing only on the most important cardiac views in order to further reduce scan time ( 16 ). During the current pandemic, it is recommend that internet-based training and education (online lectures, webinars, and use of simulators) should replace bedside training ( 17 , 18 ).…”

“…A drape covering the patient should be used to reduce physical contact if only standard protective equipment for the examiner is available. Where available, transparent drapes should be used to cover the echocardiography machine ( 16 ). The preferred examination position by the individual examiner should be maintained to ensure that the quality of the test is not compromised, as this would potentially result in re-imaging and longer examination time.…”