How to deliver echocardiography services during the COVID-19 pandemic

7th Jan 2021

The novel coronavirus (SARS-CoV-2) is highly contagious and poses potential risk to healthcare professionals, which has affected healthcare services around the world.

 

How has COVID-19 impacted echocardiography delivery? 

Since echocardiography is a patient-facing investigation that involves close patient contact over an extended period, care must be taken when considering its delivery.

To break the chain of infection, higher thresholds to perform bedside echocardiography have been implemented. In addition, there’s more focus on performing targeted studies to limit time spent at the bedside (and therefore reduce subsequent exposure of both the patient and health care workers to the virus). 

 

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There are three key principles to remember when choosing the format and level of your ECHO imaging during the COVID-19 pandemic: 

  1. The risk of infection (or the patient’s COVID-19 status)
  2. The indications for echocardiography (and the correct protocol to be used)
  3. The appropriate level of imaging

Multi-component illustration of COVID-infected women above Infection risk, checklist above Indication, and echocardiography tool above Delivery label.

Figure 1. Three key principles for echocardiography delivery during the COVID-19 pandemic include assessing the risk of infection, clarifying the indications for echocardiography, and delivering the appropriate level of imaging. 

During the COVID-19 pandemic, all routine echocardiography studies have been widely postponed with a focus on in-patient echocardiograms for patients who require urgent cardiac assessment. 

In all cases, transthoracic echocardiography (TTE) is preferred since transesophageal echocardiography (TEE) produces aerosols, and therefore presents a higher risk of spreading infection. 

 

When determining whether to perform an echocardiogram during a pandemic, the risks to both the operator and patient must be weighed against the likelihood that the echocardiography results may impact subsequent patient care. Medmastery note.

 

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Recommended reading

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  • The American Society of Echocardiography. ASE statement on protection of patients and echocardiography service providers during the 2019 novel coronavirus outbreak. 2020. ASEcho.org. https://www.asecho.org  
  • The American Society of Echocardiography. Cleaning recommendations from ultrasound manufacturers. 2020. ASEcho.org. https://www.asecho.org
  • The Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS) and Public Health England. COVID-19: Guidance for infection prevention and control in healthcare settings. Version 1.0. 2020. rcslt.org. https://www.rcslt.org 
  • Zeng, JH, Liu, YX, Yuan, J, et al. 2020. First case of COVID-19 complicated with fulminant myocarditis: A case report and insights. Infection48: 773–777. PMID: 32277408