Echocardiography in Pandemic: Front-Line Perspective, Expanding Role of Ultrasound, and Ethics of Resource Allocation

• Published in: Journal of the American Society of Echocardiography Vol. 33; no. 6; pp. 683 - 689
• Main Authors: Drake, Daniel H., De Bonis, Michele, Covella, Michele, Agricola, Eustachio, Zangrillo, Alberto, Zimmerman, Karen G., Cobey, Frederick C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2020; Mosby-Year Book
• Subjects: Betacoronavirus; Cardiovascular Diseases - complications; Cardiovascular Diseases - diagnosis; Coronavirus Infections - complications; COVID-19; Echocardiography; Echocardiography - methods; Humans; Mechanical; Pandemics; Pneumonia, Viral - complications; Resource allocation; Resource Allocation - ethics; SARS-CoV-2; Ultrasonography; Ventilators; ECMO; Ventilators; Pandemics; Echocardiography; PPE; Resource allocation; POCUS; COVID-19; SARS-CoV-2; Ultrasonography; Mechanical; ICU; ARDS
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2020.04.007

The grave clinical context of the coronavirus disease 2019 (COVID-19) pandemic must be understood. Italy is immersed in the COVID-19 pandemic. Most of the world will soon follow. The United States currently has the most documented cases of COVID-19 of any nation. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)–associated acute cardiomyopathy is common in critical care patients and is associated with a high mortality rate. Patients with COVID-19 frequently require mechanical support for adequate oxygenation. A severe shortfall of ventilators is predicted. Of equal concern is the projected shortage of trained professionals required to care for patients on mechanical ventilation. Ultrasonography is proving to be a valuable tool for identifying the pulmonary manifestations and progression of COVID-19. Lung ultrasound also facilitates successful weaning from mechanical ventilation. Ultrasonography of the lung, pleura, and diaphragm are easily mastered by experienced echocardiographers. Echocardiography has an established role for optimal fluid management and recognition of cardiac disease, including SARS-CoV-2-associated acute cardiomyopathy. Cardiologists, anesthesiologists, sonographers, and all providers should be prepared to commit their full spectrum of skills to mitigate the consequences of the pandemic. We should also be prepared to collaborate and cross-train to expand professional services as necessary. During a declared health care crisis, providers must be familiar with the ethical principles, organizational structure, practical application, and gravity of limited resource allocation.
•The gravity of the COVID-19 pandemic must be understood.•Professional staff shortages may supersede the limited supply of ventilators.•Lung ultrasonography and echocardiography are essential tools during this pandemic.•Collaboration and cross-training are required to expand professional resources.•Limited resource allocation requires ethical guideline proficiency and planning.