Health authorities need to prioritize delivery and the repurposing of mobile point-of-care ultrasound machines which have proven to be reliable, affordable, and effective in saving the lives of coronavirus patients.
Most Americans are familiar with ultrasound technology from the scans done to check on the status of the fetus during pregnancy.
But far fewer are aware of how valuable mobile versions of these units have also become in America’s emergency rooms where they almost instantly detect and record everything from internal bleeding, abdominal pain to life-threatening infections.
In recent days, mobile units have suddenly become a critical global technology for scanning the chests of coronavirus victims to precisely monitor the condition of their lungs.
We now need to raise the status of these life-saving diagnostic machines, finding and rushing them to the frontlines of hospitals where coronavirus patients are triaged and cared for.
Even before the COVID-19 pandemic, there had been elevated global demand for these mobile – called “point of care” – units that can be brought to the bedside. Some are small handheld devices that instantly connect to a smartphone.
International relief organizations and national health authorities have issued urgent calls to manufacturers in the last few days for any surplus or underutilized ultrasound equipment capable of performing lung scans. They are also seeking point-of-care ultrasound units that are underutilized or are in “retired” inventory at clinics and hospitals around the world, units that can be adapted for use in lung ultrasound (LU) diagnosis.
Sales and maintenance records from manufacturers may also be used to track down operational LU machines that are already in-country and can be drafted into urgent service during the pandemic.
Because the most desired devices are mobile and move from patient to patient, very strict hygienic procedures must be carefully monitored and managed.
As with so many technical innovations over the past half-century, taking the technology mobile was originally funded by one of the smallest but most consequential units in our U.S. military arsenal: Defense Advanced Research Projects Agency (DARPA).
DARPA didn’t invent ultrasound, but it did help shrink the technology to mobile size so that frontline military physicians could take the technology closer to the battlefield and save the lives of wounded warriors. These mobile units, now ubiquitous in ICUs and in emergency rooms around the world, are much cheaper and lower risk than radiography (x-ray) units which are difficult to maneuver to the bedside of the critically ill especially with diseases as transmittable as a coronavirus.
It turns out that these popular mobile units provide particularly precise views of distressed lungs – important tools to have when doctors need to see the exact progression of the COVID-19 virus in infected patients who are quarantined and unable to be safely moved to a remote radiology suite. COVID-19 often presents as a respiratory invader that causes acute inflammation in the lungs, primarily as a patchy, interstitial infiltrate – a condition recognized with ultrasound imaging.
A small but important study was just published in Radiology by the Radiological Society of North America (RSNA) on March 13 which comes from other doctors also on the coronavirus frontlines in Italy.
That report – covering the records of emergency physicians at Ospedale Guglielmo da Saliceto in Piacenza, Italy – claims a “strong correlation” between lung ultrasound and CT findings in patients with COVID-19 pneumonia, leading the investigators to “strongly recommend the use of bedside [ultrasound] for the early diagnosis of COVID-19 patients who present to the emergency department.”
Pneumonia and respiratory failure are a principal cause of death among COVID-19 patients. What we can assess in a lung ultrasound right now in these patients is the involvement of both lungs with basically patchy findings. Distinctive to the disease is typically ultrasonographic B lines – wide bands of hyperechoic artifacts that are often compared to the beam of a flashlight being swung back and forth.
If there is a significant consolidation, diagnostics may also capture imagery of hepatization of the lung. This information is critical to monitoring, addressing, and curing pneumonia.
For these patients and hospitals in crisis, mobile lung-ultrasound units are also scanning far more patients in a short period of time than more elaborate diagnostic imaging technologies, while delivering an accurate, actionable answer on the presence and degree of infection.
Lung ultrasound is a critical application of the point-of-care mobile units in the emergency rooms battling COVID-19 around the world, but these patients very sick with COVID-19 may also need venous access under ultrasound guidance to administer fluids and medications. Or they may be in shock and need a shock assessment, for which point-of-care ultrasound in COVID-19 resuscitation bays and ICUs are also very useful.
The COVID-19 pandemic is expected to get worse in the U.S. before it gets better. New York, California, and the State of Washington have set up military-style hospitals – 250-bed infirmaries that will be fully functional hospitals for COVID-19 patients – and will be placing point-of-care ultrasound there and elsewhere where it would be much more difficult to put a CT scanner.
The challenge in meeting that urgent goal is whether we can find and deploy enough functional lung ultrasound devices to COVID-19 responders in the next several weeks to save lives that are already in danger and restore COVID-19 patients alive and well to families desperate for medical rescue. I believe we can and will.
About Diku Mandavia, M.D.
Diku Mandavia, M.D. is the Senior Vice President, Chief Medical Officer, at FUJIFILM Sonosite Inc., and FUJIFILM Medical Systems U.S.A., Inc. He completed his residency in emergency medicine at LAC+USC Medical Center in Los Angeles where he still practices part-time. He is a Clinical Associate Professor of Emergency Medicine at the University of Southern California.
