Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Abstract

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

Usefulness of serial lung ultrasound for a severe COVID-19 patient on extracorporeal membrane oxygenation

“…However, the measurement of KL-6 levels is time-consuming and cannot be done at all facilities. Notably, LUS is the preferred imaging modality because of its utility for identifying and evaluating the serial progression of lung pathology, especially in COVID-19 pneumonitis cases where lung pathology is a characteristic feature 5 , 6 . LUS provides results that are similar to chest CT findings, and it is superior to chest radiography for the evaluation of COVID-19 23-25 .…”

“…Because the condition of the lungs varies from case to case, laboratory findings like P/F ratios do not directly correlate with the improvement of lung condition during ECMO. LUS can be evaluated individually and specifically for the lungs, and the reemergence of A-lines suggests an improvement in lung condition [3] , [4] , [5] , [6] , 8 . Although serial LUS evaluation is also considered appropriate for patients on ECMO, few studies have examined its appropriateness for COVID-19 patients 27 .…”

“…Second, LUS can be performed quickly by one clinician without displacing the patient or requiring radiation exposure 22 . Accordingly, LUS is faster, easier, and safer than other imaging modalities, with significant advantages during a pandemic 5 , 6 .…”

“…Notably, lung ultrasound (LUS) is an alternative favored imaging modality due to its utility for identifying and evaluating the serial progression of lung pathology, especially in COVID-19 patients in whom lung pathology is a key characteristic 5.6 . LUS also has other advantages, including ease of use at the point of care, which reduces the infectious risk of exposure and transmission; repeatability; absence of radiation exposure; and low cost 5 , 6 .…”

Use of the lung ultrasound score in monitoring COVID-19 patients: it’s time for a reappraisal

“…Lichter et al, on the other hand, in their study of critically ill COVID-19 patients report an optimal cutoff value of 18 on the 0–36 scale for predicting adverse outcome, with a reported sensitivity of 62% and a specificity of 75% [ 3 ], whereas Zhu et al report a sensitivity of 81% and a specificity of 96% with a cutoff value of 7 [ 4 ]. However, the study by Ji et al [ 2 ] is difficult to compare with other studies in the literature for the following two reasons: first, they used a modified LUS scale (note a recent international expert consensus on the use of multi-organ point-of-care LU in COVID-19 adopts the scale range of 0–36 [ 5 ] and does not consider the pleural line artifact); second, the patients in the study by Ji et al appear less critically ill than those in other studies, as evidenced by the fact that 88% of patients had an average value of PaO 2 /FiO 2 greater than 300 mmHg.…”