Safety and feasibility of performing pocus during the COVID-19 pandemic

Rationale: Point-of-care ultrasonography (POCUS) has a well-established role in the diagnosis and management of patients with cardiopulmonary failure and is recommended as an important frontline tool in the triage and diagnosis of patients with COVID-19. POCUS has been shown to be a safe modality for imaging patients in highly infectious settings such as Ebola, but there is limited published data on the safety and feasibility of POCUS use during periods of ICU strain in the COVID-19 pandemic. We describe our experience with POCUS in a hospital in New York City from March to May, 2020. Methods: POCUS was performed and interpreted by a competent critical care attending or fellow and primarily performed during the initial daily bedside assessment to limit number of entries and minimize exposure. POCUS exams were performed based on clinical indication and operators were encouraged to archive videos and images for documentation. Appropriate infection control procedures were followed, including hand sterilization, donning and doffing of personal protective equipment (disposable gown, gloves, N95 mask, eye shield) when entering a negative pressure room. Ultrasound machines were cleaned twice with hydrogen peroxide, both prior to and after exiting the room. We also evaluated the exposure to our intensivists after May 30th to evaluate for nosocomial transmission by means of COVID-19 antibody testing. Results: We were able to secure a dedicated portable ultrasound machine for each ICU, including newly opened surge ICUs. The consult service used a handheld ultrasound machine. Eighty-eight critically ill patients with COVID-19 disease had archived POCUS exams during this period. These patients had a median of 2 (range, 1-10) POCUS exams archived during their hospitalization. Infection control protocols were followed and a survey of all intensivists who performed said POCUS exams revealed that there was no known transmission of SARS-CoV2. Conclusions: We describe the practical aspects of incorporating POCUS in a safe and feasible manner in a critical care setting during a period of extreme strain and complex infection control requirements. Utilization of POCUS likely limited the need for further studies that might have increased risk of exposure to other healthcare personnel. There are limitations to this study, including barriers to archiving and documenting POCUS findings, likely due to operator error, time limitation, and technical issues with the machine or network connectivity. Future studies should focus on identifying barriers to POCUS archiving and documentation, description of clinical indications, findings, and change in management, if any.