key: cord-0787146-vdqm9jvo
authors: Kaminski, Abigail; Payne, Abby; Roemer, Sarah; Ignatowski, Denise; Khandheria, Bijoy K.
title: Answering to the Call of Critically Ill Patients: Limiting Sonographer Exposure to COVID-19 With Focused Protocols
date: 2020-05-12
journal: J Am Soc Echocardiogr
DOI: 10.1016/j.echo.2020.05.006
sha: 0f68506082ae6684619b326d4c38cb72e9c6f871
doc_id: 787146
cord_uid: vdqm9jvo

nan

In the midst of the worldwide COVID-19 pandemic, healthcare is seeing an increasing number of COVID-positive patients, with cases ranging from mild to fatal. Emerging data indicate that myocardial dysfunction can be detected presumably earlier than clinical decompensation by transthoracic echocardiography. However, use of echocardiography needs to be balanced against the risk for frontline sonographers of contracting COVID-19. A group of five American Registry for Diagnostic Medical Sonography-certified sonographers volunteered to form a focused cardiac imaging protocol using high-end cardiac ultrasound machines (Table 1) . Their goal was to answer to the call of critically ill COVID-positive patients while preserving protection for sonographers as this pandemic evolves.

It is essential for intensivists caring for patients with COVID-19 in the intensive care unit (ICU) to use echocardiography to thoroughly monitor biventricular systolic function as the inflammatory process takes effect. Strain imaging using speckle tracking has a proven ability to detect a decrease in systolic function prior to a decline in ejection fraction if image quality facilitates for accuracy ( Figure 1A , 1B). 1 After pertinent images have been acquired, left ventricular (LV) global longitudinal strain (GLS) and myocardial work evaluation should be completed outside of the patient room to limit the sonographer's exposure. In regard to more technically difficult patients, contrast imaging may be utilized to better visualize the endocardial definition.

Similar to LV function, there are key parameters to the proper investigation of right ventricular (RV) systolic function. It is important to obtain an RV-focused view from an elongated apical 4-chamber view (slide more laterally on the patient's chest). Obtaining this image will improve RV free wall endocardial definition, avoid foreshortening, and aid in lengthening the RV from base to apex. Additional RV parameters should include pulmonary arterial systolic pressure (PASP) as well as annular mobility (tissue Doppler imaging) for an overall comprehensive assessment of RV systolic function. In conjunction with the LV evaluation, RV longitudinal strain should be performed from the acquired RV-focused view after the sonographer leaves the patient room. Based on the most recent ASE/EACI guidelines, the septum should be omitted and only the free wall segments should be analyzed in the strain calculation ( Figures 1C, 1D ). 2, 3 The five sonographers limited their exposure while scanning patients who were positive 

Feasibility of detecting early left ventricular systolic dysfunction using global area strain: a novel index derived from three-dimensional speckletracking echocardiography

Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Guidelines for the echocardiographic assessment of the right

American Society of Echocardiography endorsed by the European Association of

Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography