Accelerated Remote Cardiopulmonary Tele-POCUS In COVID-19 Assessment
Cardiopulmonary point-of-care ultrasound (POCUS) is the critical, first-line imaging tool for patients with suspected or confirmed COVID-19 infection. However, this critical, potentially life-saving expertise, is not available in the hands of all providers treating COVID-19 infection and is especially lacking in geographically remote or rural regions. Tele-POCUS is an innovative method of streaming images and expertise to and from remote centers. ARCTICA addresses 2 clinical gaps – first by optimizing expert imaging live support to local physicians attending in COVID-19 units that are novice POCUS users, and second by implementing this novel workflow to geographically remote and Northern communities where this expertise is crucially lacking.
We anticipate that Tele-POCUS will result in rapid interpretation, stratification, bedside decision-making, and triage of patients, as well as help the treating physician identify which patients are at risk of clinical deterioration, require urgent therapy, or transfer, ultimately saving lives. Saving lives of patients with COVID-19 infection is the driving force for the implementation of a technologically driven approach to enhance care in remote regions, but the remaining conduit, once established, will elevate imaging to these settings beyond the pandemic.
Expected Outcomes and Significance: We expect to demonstrate the effectiveness and value of a POCUS tele-consultative service for enhancing care of patients with COVID-19 infection, integration with clinical workflow, and the acceleration of training of front-line physicians. We anticipate this program to not only develop a practical, critical skill set for our physicians locally, but to also provide a workflow model that will serve the global community during the pandemic.
ARTICA Program design: Using a fully virtual teaching format, and live-streamed point-of-care ultrasound (POCUS), experts at Hub Sites will assist patient diagnosis in both local and remote COVID-19 units at Spoke Sites. This Hub-and-Spoke model will have primary sites dedicated to specific remote locations. The Queen’s University ‘hub’ will provide expert Tele-POCUS services to communities within the Weeneebayko Area Health Authority (WAHA) ‘spoke’. The University of Toronto ‘hub’ will provide expert Tele-POCUS services to the Sioux Lookout Meno Ya Win Health Centre (SLMHC) ‘spoke’. The Dalhousie University ‘hub’ will provide expert Tele-POCUS services to the Yarmouth Health Centre ‘spoke’. The University of Calgary ‘hub’ will provide expert Tele-POCUS Services to the Whitehorse Health Centre ‘spoke’. The University of Manitoba ‘hub’ will provide expert Tele-POCUS services to the Qikiqtani General Hospital, Iqaluit ‘spoke’.
Participants will have access to three POCUS modules:
Module I: POCUS Basics will introduce you to the fundamentals of point-of-care ultrasound. Specifically, by the end of this module you will be able to:
- Understand the role of POCUS
- Understand and apply basic physics principles in POCUS
- Select the correct transducer for intended application
- Understand the role of presets and knobology to optimize image quality
- Apply device and software-specific knowledge using provided equipment
Module II: Cardiac POCUS will introduce you to the important views in cardiac point-of-care ultrasound, as well as relevant pathological findings. Specifically, by the end of this module you will be able to:
- Acquire five basic cardiac POCUS views
- Identify the gross anatomy within each POCUS view
- Identify and interpret common cardiac POCUS pathologies
- Identify and interpret relevant cardiac POCUS pathologies for patients with suspected or confirmed COVID-19 (from the American Society of Echocardiography Statement on POCUS During the COVID-19 Pandemic)
Module III: Lung & Pleura POCUS will introduce you to the important views in lung point-of-care ultrasound, as well as relevant pathological findings. Specifically, by the end of this module you will be able to:
- Understand the basic theory, principles, and protocol for lung POCUS
- Identify the common anatomy and artifacts observed in lung POCUS
- Identify and interpret common lung POCUS pathologies
- Identify and interpret relevant lung POCUS pathologies for patients with suspected or confirmed COVID-19