J Am Coll Emerg Physicians Open. 2020 Jul 21:10.1002/emp2.12194. doi: 10.1002/emp2.12194. Online ahead of print.
Coronavirus disease 2019 (COVID-19) has created unprecedented disruption for global healthcare systems. Offices and emergency departments (EDs) were the first responders to the pandemic, followed by medical wards and intensive care unit (ICUs). Worldwide efforts sprouted to coordinate proper response by increasing surge capacity and optimizing diagnosis and containment. Within the complex scenario of the outbreak, the medical community shared scientific research and implemented best-guess imaging strategies in order to save time and additional staff exposures. Early publications showed agreement between chest computed tomography (CT) and lung sonography: widespread ground-glass findings resembling acute respiratory distress syndrome (ARDS) on CT of COVID-19 patients matched lung ultrasound signs and patterns. Well-established accuracy of bedside sonography for lung conditions and its advantages (such as no ionizing radiation; low-cost, real-time bedside imaging; and easier disinfection steps) prompted a wider adoption of lung ultrasound for daily assessment and monitoring of COVID-19 patients. Growing literature, webinars, online materials, and international networks are promoting lung ultrasound for the same purpose. We propose 11 lung ultrasound roles for different medical settings during the pandemic, starting from the out-of-hospital setting, where lung ultrasound has ergonomic and infection control advantages. Then we describe how medical wards and ICUs can safely integrate lung ultrasound into COVID-19 care pathways. Finally, we present outpatient use of lung ultrasound to aid follow-up of positive case contacts and of those discharged from the hospital.