Background: Coronavirus disease-2019 (COVID-19) causes various cardiopulmonary manifestations. Bedside ultrasound helps in the rapid diagnosis of these manifestations. Vscan Extend™ (GE, Wauwatosa, WI, USA) is a handheld ultrasound device with a dual probe and an artificial intelligence application to detect ejection fraction. It can help in reducing the time for diagnosis, duration, and the number of healthcare workers exposed to COVID-19. This is a prospective observational study comparing the cardiorespiratory parameters and time duration for assessment between Vscan Extend™ and the conventional ultrasound machine.
Materials and methods: Paired observations were made in 96 COVID-19 patients admitted to the intensive care unit by two intensivists. Intensivist A used the Vscan Extend™ device to assess the cardiac function, lung fields, diaphragm, deep veins, and abdomen. Intensivist B used clinical examination, X-ray chest, ECG, and conventional echocardiogram for assessment. The agreement between the findings and the time duration required in both the methods was compared.
Results: The use of handheld ultrasound has significantly decreased the duration of bedside examination of patients than the conventional method. The median duration of examination using handheld ultrasound was 9 (8.0–11.0) minutes, compared to 20 (17–22) minutes with the conventional method (P < 0.001). The Cohen's kappa coefficient was 1.0 for left ventricular systolic function, most of the lung fields, and diaphragmatic movement.
Conclusion: Vscan Extend™ helps in the rapid identification and diagnosis of cardiopulmonary manifestations in COVID-19 patients. The agreement between the handheld device and the conventional method proves its efficacy and safety.
CTRI Number: CTRI/2020/07/026701
Halbach JL, Prieto JM, Wang AW, Hawisher D, Cauvi DM, Reyes T, et al. Early hyperbaric oxygen therapy improves survival in a model of severe sepsis. Am J Physiol Integr Comp Physiol 2019;317(1):R160–R168. DOI: 10.1152/AJPREGU.00083.2019.
Adukia SA, Ruhatiya RS, Maheshwarappa HM, Manjunath RB, Jain GN. Extrapulmonary features of COVID-19: a concise review. Indian J Crit Care Med 2020;24(7):575–580. DOI: 10.5005/jp-journals-10071-23476.
Peng Q, Wang X, Zhang L, Chinese Critical Care Ultrasound Study Group (CCUSG). Using echocardiography to guide the treatment of novel coronavirus pneumonia. 2020;24(1):143. DOI: 10.1186/s13054-020-02856-z.
World Health Organization. Transmission of SARS-CoV-2: implications for infection prevention precautions. In: Scientific brief. Geneva: World Health Organization; 2020, pp. 1–23.
Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound 2014;12(1):25. DOI: 10.1186/1476-7120-12-25.
Tsutsui JM, Maciel RR, Costa JM, Andrade JL, Ramires JF. Hand-carried ultrasound performed at bedside in cardiology inpatient setting – a comparative study with comprehensive echocardiography. Cardiovasc Ultrasound 2004;2:24. DOI: 10.1186/1476-7120-2-24.
Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically ill patients. Am J Respir Crit Care Med 2019;199(6):701–714. DOI: 10.1164/rccm.201802-0236CI.
Huang R, Poffenberger CM, Nguyen PD. Point-of-care ultrasound in austere environments a complete review of its utilization, pitfalls, and technique for common applications in austere settings. Emerg Med Clin 2017;35(2):409–441. DOI: 10.1016/J.EMC.2016.12.007.
Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. Ultrasound J 2019;11(1):31. DOI: 10.1186/s13089-019-0145-4.
Lichtenstein DA. Lung ultrasound in the critically ill. Intensive Care Med 2004;30(2):183–184. DOI: 10.1007/s00134-003-2083-6.
Senniappan K, Sreedhar R, Babu MS, Dash PK, Gadhinglajkar SV, Sukesan S. Bedside lung ultrasound for postoperative lung conditions in cardiothoracic intensive care unit: Diagnostic value and comparison with bedside chest roentgenogram. Anesthesia 2019;13(4):649. DOI: 10.4103/aer.AER_125_19.
Guarracino F, Vetrugno L, Forfori F, Corradi F, Orso D, Bertini P, et al. Lung, heart, vascular, and diaphragm ultrasound examination of COVID-19 patients: a comprehensive approach. J Cardiothorac Vasc Anesth 2020;6:13. DOI: 10.1053/j.jvca.2020.06.013.
Kajimoto K, Madeen K, Nakayama T, Tsudo H, Kuroda T, Abe T. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting. Cardiovasc Ultrasound 2012;10(1):49. DOI: 10.1186/1476-7120-10-49.
Gibson LE, Bittner EA, Chang MG. Handheld ultrasound devices: an emerging technology to reduce viral spread during the Covid-19 pandemic. Am J Infect Control 2020;48(8):968–969. DOI: 10.1016/j.ajic.2020.05.041.
ACR recommendations for the use of chest radiography and computed tomography (CT) for suspected COVID-19 infection. Available from: https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection
Khanji MY, Ricci F, Patel RS, Chahal AA, Bhattacharyya S, Galusko V, et al. The role of hand-held ultrasound for cardiopulmonary assessment during a pandemic. Prog Cardiovasc Dis 2020;63(5):690–695. DOI: 10.1016/j.pcad.2020.07.003.
Qian F, Zhou X, Zhou J, Liu Z, Nie Q. A valuable and affordable handheld ultrasound in combating COVID-19. Crit Care 2020;24(1):334. DOI: 10.1186/s13054-020-03064-5.