CORONA (COre ultRasOund of covid in iNtensive care and Acute medicine) study: National service evaluation of lung and heart ultrasound in intensive care patients with suspected or proven COVID-19

Abstract

Background Combined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart - formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic. Method Twelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1st February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database. Results 372 studies were performed on 265 patients. There was a small but significant relationship between LUS score >8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction ( p < 0.05). Change in management occurred in 65% of patients following a combined scan. Conclusions In COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication.

Intensive care nurse‐led point of care ultrasound in the assessment and management of the critically ill COVID‐19 patient: A single centre case series

“…Sixty‐five percent of scans led to a change in management. This finding is echoed by the larger ICS service evaluation data set 14 . Comparable interventions (e.g., fluid management, image requests and patient triage) were identified in 69% of patients in a larger observational study 33…”

“…This finding is echoed by the larger ICS service evaluation data set. 14 Comparable interventions (e.g., fluid management, image requests and patient triage) were identified in 69% of patients in a larger observational study. 33 Introducing nurse-led PoCUS into routine ICU care may increase the availability of PoCUS for all ICU patients and contribute to timely changes in patient management 12 in a higher proportion of patients.…”

“…This case series was conducted as part of a national service evaluation project led by the Intensive Care Society and Society of Acute Medicine. 14 Approval was given by the lead for critical care ultrasound at King's College Hospital. As such, written patient consent was not required.…”

“…Both cardiac and lung PoCUS are performed regularly and incorporated into the clinical management of the ICU patient. In 2020, the Society of Acute Medicine (SAM) and the ICS led a UK national service evaluation of PoCUS in patients with SARS‐CoV‐2 14 . This case series reports the findings of this service evaluation at our centre (KCH).…”

Point-of-care ultrasound use in COVID-19: a narrative review

“…Serial ultrasonography using LUS and Focused UltraSound for Intensive Care heart (FUSIC Heart) were able to risk-stratify patients with COVID-19. The CORONA study found an association between LUS score, right ventricular dysfunction, and mortality ( 139 ).…”