CSANZ Imaging Council Position Statement on Echocardiography Services During the COVID-19 Pandemic

Abstract

In light of the rapidly evolving COVID-19 pandemic, it was considered important for the CSANZ Imaging Council to provide a position statement to guide clinical practice and facilitate resource and service planning appropriately.This statement represents expert consensus opinion, available evidence and international guidelines. Given the changing nature of our understanding of COVID-19, institutional protocols should increasingly be guided by evidence-based practices and recommendations.It is important to emphasise that this is a general statement and that individual laboratories should consider their unique circumstances in adapting this statement to their situation. We are mindful that we cannot totally stop providing outpatient services until we reach a critical stage (as advised by state and local health networks). However, rationalising resources and services to prepare for the pandemic and demand is crucial.

COVID-19 and Acute Heart Failure: Screening the Critically Ill – A Position Statement of the Cardiac Society of Australia and New Zealand (CSANZ)

“…If there are also ECG changes (see below) then this should trigger a transthoracic echocardiogram (TTE) [13], with limited views (see below). Otherwise, a hsTn should be undertaken daily and an ECG second daily (see caveat below) in the HDU/ICU.…”

“…2. For patients in the HDU/ICU/telemetry setting, an elevated hsTn (greater than 99 th centile for the assay), which continues to rise (in the absence of chest pain) over three consecutive days with or without ECG changes (see below) should trigger a targeted TTE [13] (see below). Haemodynamic instability (e.g.…”

“…It is not only left ventricular systolic function that is important but also the left ventricular morphology and size, which in themselves are prognostic, particularly in these younger patients with acute heart failure. As indicated in the Cardiac Society of Australia and New Zealand (CSANZ) Imaging COVID-19 position statement [13], TTE should be used judiciously to avoid unnecessary staff exposure, and all personal protective precautions be made available.…”

COVID-19 and Heart, Lung and Circulation: Riding the 2020 Waves of Change in Australia & New Zealand✰

“…Adaptive health care delivery models and resource allocation would be required throughout the health care system [ 1 ]. Subsequently, nine comprehensive CSANZ Position or Consensus Statements [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ] and an Executive Summary of a tenth [ 16 ], were fast-tracked to on-line publication in Heart, Lung and Circulation . Designed as “living documents” that would be revised as needed (e.g., when more detailed information became available), each Statement comprehensively outlined the changed models of care with respect to different aspects of cardiovascular practice: acute heart failure and assessing the critically ill [ 7 ] assessing suspected acute coronary syndromes [ 8 ], interventional cardiology services delivery [ 9 ], echocardiography services [ 10 ], management of cardiac electrophysiology and cardiac implantable electronic devices [ 11 ], genetic heart diseases [ 12 ], paediatric and congenital heart disease [ 13 ], cardiac rehabilitation and secondary prevention [ 14 ], rural and remote cardiology [ 15 ], and cardiovascular nursing [ 16 ].…”

Reducing Potential COVID-19 Exposure With Coronary Computed Tomography for Left Atrial Appendage Assessment: A Tool For Our Time

“…Aerosol generating procedures such as transoesophageal echocardiography (TOE) have been associated with a high risk of exposure to the operator and anaesthetic staff. Imaging Council guidelines released during the initial phase recommend delaying elective TOE for a minimum of 3 months [ 1 ]. However this is not a long-term solution if the pandemic becomes endemic.…”