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. 2021 Aug 5;10(16):3466.
doi: 10.3390/jcm10163466.

Reshaping of Italian Echocardiographic Laboratories Activities during the Second Wave of COVID-19 Pandemic and Expectations for the Post-Pandemic Era

Quirino Ciampi  1 , Francesco Antonini-Canterin  2 , Andrea Barbieri  3 , Agata Barchitta  4 , Frank Benedetto  5 , Alberto Cresti  6 , Sofia Miceli  7 , Ines Monte  8 , Licia Petrella  9 , Giuseppe Trocino  10 , Iolanda Aquila  11 , Giovanni Barbati  12 , Valentina Barletta  13 , Daniele Barone  14 , Monica Beraldi  15 , Gianluigi Bergandi  16 , Giuseppe Bilardo  17 , Giuseppe Boriani  3 , Eduardo Bossone  18 , Amedeo Bongarzoni  19 , Francesca Elisa Bovolato  20 , Francesca Bursi  21 , Valeria Cammalleri  22 , Marco Carbonella  23 , Grazia Casavecchia  24 , Sebastiano Cicco  25 , Giovanni Cioffi  26 , Rosangela Cocchia  18 , Paolo Colonna  27 , Lauro Cortigiani  28 , Umberto Cucchini  29 , Maria Grazia D'Alfonso  30 , Antonello D'Andrea  31 , Luca Dell'Angela  32 , Ilaria Dentamaro  33 , Marcella De Paolis  34 , Paola De Stefanis  35 , Wanda Deste  8 , Maria Di Fulvio  36 , Giovanna Di Giannuario  37 , Daniela Di Lisi  38 , Concetta Di Nora  39 , Iacopo Fabiani  40 , Roberta Esposito  41 , Fabio Fazzari  42 , Luigi Ferrara  43 , Gemma Filice  44 , Davide Forno  45 , Mauro Giorgi  46 , Enrico Giustiniano  47 , Cosimo Angelo Greco  48 , Gian Luca Iannuzzi  49 , Annibale Izzo  50 , Alberto Maria Lanzone  51 , Alessandro Malagoli  52 , Francesca Mantovani  53 , Vincenzo Manuppelli  54 , Simona Mega  55 , Elisa Merli  56 , Margherita Ministeri  57 , Doralisa Morrone  58 , Cosimo Napoletano  9 , Luigi Nunziata  59 , Guido Pastorini  60 , Chiara Pedone  61 , Enrica Petruccelli  62 , Maria Vincenza Polito  63 , Vincenzo Polizzi  64 , Costantina Prota  65 , Fausto Rigo  66 , Dante Eduardo Rivaben  2 , Silvio Saponara  67 , Angela Sciacqua  7 , Chiara Sartori  68 , Virginia Scarabeo  69 , Walter Serra  70 , Sergio Severino  71 , Luciano Spinelli  72 , Gloria Tamborini  73 , Antonio Tota  27 , Bruno Villari  1 , Scipione Carerj  74 , Eugenio Picano  75 , Mauro Pepi  73 , SIECoVId Study Group On Behalf Of The Italian Society Of Echocardiography And Cardiovascular Imaging Siecvi
Affiliations

Reshaping of Italian Echocardiographic Laboratories Activities during the Second Wave of COVID-19 Pandemic and Expectations for the Post-Pandemic Era

Quirino Ciampi et al. J Clin Med. .

Abstract

Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era.

Methods: We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019).

Results: During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by using appropriate personal protection equipment. Operators wore FFP2 in 58 centers (83%) during trans-thoracic echocardiography (TTE), in 65 centers (93%) during transesophageal echocardiography (TEE) and 63 centers (90%) during stress echocardiography. The second wave caused a significant reduction in number of echocardiographic exams, compared to November 2019 (from 513 ± 539 to 341 ± 299 exams per center, -34%, p < 0.001). On average, there was a significant increase in the outpatient waiting list for elective echocardiographic exams (from 32.0 ± 28.1 to 45.5 ± 44.9 days, +41%, p < 0.001), with a reduction of in-hospital waiting list (2.9 ± 2.4 to 2.4 ± 2.0 days, -17%, p < 0.001). We observed a large diffusion of point-of-care cardiac ultrasound (88%), with a significant increase of lung ultrasound usage in 30 centers (43%) during 2019, extended to all centers in 2020. Carbon dioxide production by examination is an indicator of the environmental impact of technology (100-fold less with echocardiography compared to other cardiac imaging techniques). It was ignored in 2019 by 100% of centers, and currently it is considered potentially crucial for decision-making in cardiac imaging by 65 centers (93%).

Conclusions: In one year, major changes occurred in echocardiography practice and culture. The examination structure changed with extensive usage of point-of-care cardiac ultrasound and with lung ultrasound embedded by default in the TTE examination, as well as the COVID-19 testing.

Keywords: COVID-19; lung ultrasound; point-of-care cardiac ultrasound.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Percentage difference from November 2019 (black bar) to November 2020 (gray bars) in echocardiographic examinations, waiting list outpatients and waiting list in-hospital patients.
Figure 2
Figure 2
Percentage difference from November 2019 (black bar) to November 2020 (gray bars) in lung ultrasound evaluation in resting TTE, joint reading assessment with intensivists and awareness of carbon dioxide (CO2) impact in cardiac imaging.
See this image and copyright information in PMC

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