Application of Lung Ultrasound During the COVID-19 Pandemic: A Narrative Review

Convissar, David; Gibson, Lauren E.; Berra, Lorenzo; Bittner, Edward A.; Chang, Marvin G.

doi:10.1213/ane.0000000000004929

Cited by 68 publications

(94 citation statements)

References 15 publications

(36 reference statements)

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“…Surprisingly, the use of lung ultrasound in the pre-hospital setting is very limited, although it could help diagnose emergency patients with dyspnoea. Portable point-of-care ultrasound (POCUS) is a safe and effective bedside pre-hospital tool which can be used for initial evaluation and management in patients with confirmed or suspected COVID-19 infection [ 18 ]. The data of our survey show that even in modern, well-equipped European air ambulance systems with highly trained specialists, the potential for improvement in pre-hospital POCUS exists.…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective

Hilbert-Carius

Braun²,

Abu‐Zidan

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background COVID-19, the pandemic caused by the severe acute respiratory syndrome coronavirus-2, is challenging healthcare systems worldwide. Little is known about problems faced by emergency medical services—particularly helicopter services—caring for suspected or confirmed COVID-19 patients. We aimed to describe the issues faced by air ambulance services in Europe as they transport potential COVID-19 patients. Methods Nine different HEMS providers in seven different countries across Europe were invited to share their experiences and to report their data regarding the care, transport, and safety measures in suspected or confirmed COVID-19 missions. Six air ambulance providers in six countries agreed and reported their data regarding development of special procedures and safety instructions in preparation for the COVID-19 pandemic. Four providers agreed to provide mission related data. Three hundred eighty-five COVID-19-related missions were analysed, including 119 primary transport missions and 266 interfacility transport missions. Results All providers had developed special procedures and safety instructions in preparation for COVID-19. Ground transport was the preferred mode of transport in primary missions, whereas air transport was preferred for interfacility transport. In some countries the transport of COVID-19 patients by regular air ambulance services was avoided. Patients in interfacility transport missions had a significantly higher median (range) NACA Score 4 (2-5) compared with 3 (1-7), needed significantly more medical interventions, were significantly younger (59.6 ± 16 vs 65 ± 21 years), and were significantly more often male (73% vs 60.5%). Conclusions All participating air ambulance providers were prepared for COVID-19. Safe care and transport of suspected or confirmed COVID-19 patients is achievable. Most patients on primary missions were transported by ground. These patients were less sick than interfacility transport patients, for whom air transport was the preferred method.

show abstract

Section: Discussionmentioning

confidence: 99%

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective

Hilbert-Carius

Braun²,

Abu‐Zidan

et al. 2020

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…Surprisingly, the use of lung ultrasound in the pre-hospital setting is very limited, although it could help diagnose emergency patients with dyspnoea. Portable point-of-care ultrasound (POCUS) is a safe and effective bedside pre-hospital tool which can be used for initial evaluation and management in patients with con rmed or suspected COVID-19 infection (21). The data of our survey show that even in modern, well-equipped European air ambulance systems with highly trained specialists, the potential for improvement in pre-hospital POCUS exists.…”

Section: Medical Interventionsmentioning

confidence: 94%

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: An air ambulance perspective.

Hilbert-Carius

Braun²,

Abu‐Zidan

et al. 2020

Preprint

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Background: COVID-19, the pandemic caused by the severe acute respiratory syndrome coronavirus-2, is challenging healthcare systems worldwide. Little is known about problems faced by emergency medical services—particularly helicopter services—caring for suspected or confirmed COVID-19 patients. We aimed to describe the issues faced by air ambulance services in Europe as they transport potential COVID-19 patients.Methods: Nine different HEMS providers across Europe were invited to share their experiences and to report their data regarding the care, transport, and safety measures in suspected or confirmed COVID-19 missions. Six air ambulance providers agreed and reported their data. 385 COVID-19-related missions were analysed, including 119 primary transport missions and 266 interfacility transport missions.Results: All providers had developed special procedures and safety instructions in preparation for COVID-19. Ground transport was the preferred mode of transport in primary missions, whereas air transport was preferred for interfacility transport. In some countries the transport of COVID-19 patients by regular air ambulance services was avoided. Patients in interfacility transport missions had a significantly higher median (range) NACA Score 3 (1-7) compared with 4 (2-5), needed significantly more medical interventions, were significantly younger (59.6±16 vs 65±21 years), and were significantly more often male (73% vs 60.5%). Conclusions: All participating air ambulance providers were prepared for COVID-19. Safe care and transport of suspected or confirmed COVID-19 patients is achievable. Most patients on primary missions were transported by ground. These patients were less sick than interfacility transport patients, for whom air transport was the preferred method.

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“…This ultrasound finding may guide the decision to initiate antibiotics. 24 Characteristic sonographic patterns on LUS may help categorise patients into groups with low probability, moderate probability, high probability and a further group with alternate pathology other than COVID-19. 23 Accurate interpretation may present a challenge to novice operators since there is a degree of subjectivity involved in these classifications.…”

Section: Lus Abnormalities In Covid-19mentioning

confidence: 99%

Combatting COVID-19: is ultrasound an important piece in the diagnostic puzzle?

2020

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The current COVID-19 pandemic is causing diagnostic and risk stratification difficulties in Emergency Departments (ED) worldwide. Molecular tests are not sufficiently sensitive, and results are usually not available in time for decision making in the ED. Chest x-ray (CXR) is a poor diagnostic test for COVID-19, and computed tomography (CT), while sensitive, is impractical as a diagnostic test for all patients. Lung ultrasound (LUS) has an established role in the evaluation of acute respiratory failure and has been used during the COVID-19 outbreak as a decision support tool. LUS shows characteristic changes in viral pneumonitis, and while these changes are not specific for COVID-19, it may be a useful adjunct during the diagnostic process. It is quick to perform and repeat and may be done at the bedside. The authors believe that LUS can help to mitigate uncertainty in undifferentiated patients with respiratory symptoms. This review aims to provide guidance regarding indications for LUS, describe the typical sonographic abnormalities seen in patients with COVID-19 and provide recommendations around the logistics of performing LUS on patients with COVID-19 and managing the infection control risk of the procedure. The risk of anchoring bias during a pandemic and the need to consider alternative pathologies are emphasised throughout this review. LUS may be a useful point-of-care test for emergency care providers during the current COVID-19 pandemic if used within a strict framework that governs education, quality assurance and proctored scanning protocols.

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Application of Lung Ultrasound During the COVID-19 Pandemic: A Narrative Review

Cited by 68 publications

References 15 publications

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: An air ambulance perspective.

Combatting COVID-19: is ultrasound an important piece in the diagnostic puzzle?

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Application of Lung Ultrasound During the COVID-19 Pandemic: A Narrative Review

Cited by 68 publications

References 15 publications

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective

Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: an air ambulance perspective

Pre-hospital care &amp; interfacility transport of 385 COVID-19 emergency patients: An air ambulance perspective.

Combatting COVID-19: is ultrasound an important piece in the diagnostic puzzle?

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Pre-hospital care & interfacility transport of 385 COVID-19 emergency patients: An air ambulance perspective.