key: cord-0724385-ow15l6dc authors: Johri, Amer M.; Galen, Benjamin; Kirkpatrick, James N.; Lanspa, Michael; Mulvagh, Sharon; Thamman, Ritu title: ASE Statement on Point-of-Care Ultrasound (POCUS) During the 2019 Novel Coronavirus Pandemic date: 2020-04-15 journal: J Am Soc Echocardiogr DOI: 10.1016/j.echo.2020.04.017 sha: 95f12715f74695d81c6c33d50a06b316a645bc05 doc_id: 724385 cord_uid: ow15l6dc nan and should not be used as the sole basis to make medical practice decisions or for disciplinary action against any employee. The statements and recommendations contained in these reports are primarily based on the opinions of experts, rather than on scientifically-verified data. ASE makes no express or implied warranties regarding the completeness or accuracy of the information in these reports, including the warranty of merchantability or fitness for a particular purpose. In no event shall ASE be liable to you, your patients, or any other third parties for any decision made or action taken by you or such other parties in reliance on this information. Nor does your use of this information constitute the offering of medical advice by ASE or create any physician-patient relationship between ASE and your patients or anyone else. Although lung injury is common in COVID-19 infection, myocardial injury may be present in more than a quarter of patients with critical disease. 1 2. Early identification of worsening cardiac function, either due to known pre-existing disease or associated with the infection. 3. Monitoring and examination: POCUS may be able to assess changes in cardiac function over time through quick routine examinations, perhaps in lieu of heart and lung auscultation, which can be challenging in critical care settings due to pronation, ambient noise, and PPE. a. Early reports suggest that some patients develop pericardial effusion and/or myocarditis that can progress to shock. 4 b. A hypercoagulable state may be associated, leading to deep venous thrombosis (DVT) and pulmonary embolism with associated right ventricular findings and acute pulmonary hypertension c. LV systolic dysfunction, either global or regional, may be associated with myocarditis, stress-induced cardiomyopathy pattern, or epicardial or microvascular coronary thrombosis. When radiographic studies such as CT scan might be limited, lung POCUS can be used to trend severity of COVID-19 pneumonia as an adjunct to oximetry and physical examination. Lung and vascular POCUS applications in COVID-19 are listed in Table 1 Table 2 (modified from the American College of Emergency Physicians (ACEP)) 6 . This is a suggested checklist; however specific steps, procedures, and their order may vary depending upon institutional guidance, the care environment, and management pathway. It is important to recognize that institutions may develop their own protocols for decontamination; and that these should be posted clearly. introductory lung modules available at PocusJournal.com. 11 To enhance training and enable access to experts, commercially available platforms now exist that utilize interactive teleconsultative tools for remote guidance and supervision. In the case that cardiopulmonary ultrasound is indicated in a patient with A modified POCUS protocol to assist in the assessment of COVID-19 patients includes heart, chest and vessel views. Hold in-service for users, share knowledge Consider probe/device covers (institution-specific) 8 Consider dedicating machine to unit (institution-specific) 9 Hold in-service for users, share knowledge COVID-19) and Cardiovascular Disease. Circulation. 2020 Cardiovascular Point-of-Care Imaging for the Medical Student and Novice User Bedside Cardiac Ultrasound in COVID-19 Infection From the Wuhan Epicenter: Role of Cardiac Point of Care Ultrasound (POCUS), Limited Transthoracic Echocardiography, and Critical Care Echocardiography Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department: A meta-analysis Ultrasound Machine Cleaning Process for COVID-19 Disinfectants for Use Against SARS-CoV-2. United States Environmental Protection Agency Guidelines for Cleaning and Preparing External-and Internal-Use Ultrasound Transducers and Equipment Between Patients as well as Safe Handling and Use of Ultrasound Coupling Gel. American Institute of Ultrasound in Medicine Recommendations for Echocardiography Laboratories Participating in Cardiac Point of Care Cardiac Ultrasound (POCUS) and Critical Care Echocardiography Training: Report from the American Society of Echocardiography United States Resource Availability for COVID-19. Society of Critical Care Medicine. sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19?_zs=jxpjd1&_zl=w9pb6 Introduction to Lung POCUS