Ultrasound in COVID Across the Globe: Global Insights from the Web

ACEP Global Ultrasound Subcommittee

With the spread of the novel coronavirus across the globe, physicians around the world are uniting to work together to try to combat this pandemic. Point-of-care ultrasound (POCUS) has been on the forefront of many of these discussions as physicians from China, Italy, Spain, and elsewhere describe their experiences treating patients sickened with COVID-19. Although formal research is limited, lots of useful knowledge is being disseminated in non-traditional paths such as webinars and blogposts. Our interconnectedness is on display as clinicians worldwide share their experiences with POCUS while battling COVID-19. The following are some insights from physicians around the globe on ultrasound during the pandemic.

Ultrasound in Italy

Dr. Giovanni Volpicelli, working at the University Hospital San Luigi Gonzaga in Turin, reports that lung ultrasound has become the primary imaging modality for patients at his hospital, using it more than computed tomography (CT) or even chest radiography.^1,2 He states lung ultrasound has been used to guide diagnosis and triage for patients and is being used serially once a patient is admitted. Dr. Enrico Storti at Maggiore Hospital describes a similar approach in the Emergency Department in Lodi, Italy, an epicenter of the Italian outbreak. Dr. Storti describes using ultrasound, in conjunction with blood gas and chest radiography, to evaluate lung involvement and more appropriately triage a patient’s level of care.³ He emphasized that ultrasound could help with the burden of a high number of patients who are extremely ill.

Ultrasound in China

Drs. Xiaoting Wang and Yangong Chao shared their experience using ultrasound on the frontlines in China.⁴ They describe using ultrasound in the ICU to monitor patients with critical COVID-19 disease including performing serial cardiopulmonary ultrasounds and speculating that this pandemic will make lung ultrasound a core-skill in critical care in the future. The China Critical Ultrasound Research Group also published guidelines to for using ultrasound in patients with COVID-19. Their work includes a description of pulmonary ultrasound findings and typical cardiac findings.⁵

Ultrasound in Spain

As many people around the world have been watching, Dr. Yale Tung Chen, an emergency physician at Hospital Universitario La Paz in Spain, broadcast daily updates on his own lung ultrasound findings as he self-quarantined with COVID-19 infection.⁶ He describes how he could see the lung ultrasound progressing about a day before he would clinically worsen. Fortunately, Dr. Chen has recovered and is back in the hospital now scanning his own patients.

World Stage

As high-resource countries struggle to control and manage COVID-19, we can only predict that the toll will be higher for those in resource-poor areas with less public health and medical infrastructure. POCUS has been growing in popularity and availability in low- and middle-income settings and may in fact become a key tool for areas that lack CT scanners and other diagnostics. With this in mind, it is a priority for all of us to learn as much as we can about this disease and to spread that knowledge freely. We are in this together as an international community, and we will continue to work together to share knowledge and save lives. Stay safe everyone.

References:

1. Under pressure, one Italian doctor triages by ultrasound. Medscape. Liam Davenport, March 24, 2020. https://www.medscape.com/viewarticle/927470#vp_2
2. Triage of Covid-19 patients using lung ultrasound: Lessons from the front line. https://www.youtube.com/watch?v=9m4CX6q54Go Accessed April 13, 2020.
3. Fujifilm Sonosite Chief Medical Officer Diku Mandavia, MD, interviews Dr. Enrico Storti on COVID-19. https://www.youtubcom/watch?v=ZTfqzRWNa2U&t=522s. Accessed April 13, 2020.
4. The Use of Ultrasound in China for Diagnosis of Novel Coronavirus (COVID-19) Pneumonia. https://www.youtube.com/watch?v=UT7hscsawe4. Accessed April 13, 2020.
5. CCUSG-Recommended treatment of severe new coronary virus pneumonia based on critical ultrasound (first edition). China Critical Ultrasound Research Group (CCUSG), Critical Hemodynamic Treatment Collaborative Group of Chinese Medical Association (CHTCGroup). Modified on 2020-02-19.
6. Personal Twitter page – Yale Tung Chen, MD. https://twitter.com/yaletung?lang=en

Jessica Schmidt, MD
Assistant Professor, Director, Global Health/Emergency Medicine University of Wisconsin.
@jschmidt_md