Fighting COVID-19 Together

Dr. John Martin (Chief Medical Officer), Rick Mendez (Head of Clinical Development), Dr. Mike Stone (Head of Education) and special guest, Dr. Yale Tung Chen are featured in this webinar. Dr. Chen tested positive for COVID-19 on March 9 and used the Butterfly iQ to track the progression of his condition. He spoke about his experience and the value of POCUS during the COVID-19 pandemic.

Webinar Q&A

Is there a clinical setting in which lung ultrasound is more specific than other modalities?

Clinical evidence consistently suggests that lung ultrasound has a higher sensitivity than CXR in lung conditions such as pneumonia. Review this (https://butterflynetwork.com/case-studies/is-antibiotic-therapy-the-best-course-of-care) case study discussion for more details. 

Do you have recommendations on how to disinfect probes used on suspected COVID patients? 

A full list of chemically compatible cleaners/disinfectants and other recommended best practices are available on the cleaning (https://bfiq1.webflow.io/covid19/cleaning-and-disinfection) section of our COVID-19 resource center.  

How accurate are these ultrasound images as compared to the traditional/conventional ultrasound machines in a healthcare setting?

A key part of the regulatory process associated with the development of a new medical device is to prove substantial equivalance to a predicate, and Butterfly iQ is no exception. In this process, it is mandatory to demonstrate equivalent-or-better performance than products currently on the market. 

How similar or dissimilar is lung ultrasound for COVID-19 from other viral or bacterial pneumonia pocus findings?

Initial findings suggest that the ultrasound appearances of COVID-19 pneumonia demonstrate patchy/confluent B-lines, subpleural consolidations and/or a thickened, irregular pleural line. While many of these findings can be seen in viral (and more rarely bacterial) pneumonia, the diffuse and bilateral postero-inferior locations are more typical of COVID-19 as opposed to bacterial pneumonia.

If you’re monitoring patients in an outpatient setting, should you repeat POCUS or have them come in for an O2 evaluation? 

If possible, stable patients with abnormal lung imaging findings that don’t require hospitalization can be monitored at home, ideally with pulse oximetry and health care practitioner contact through phone or telemedicine.

What is the role of cardiac ultrasound in COVID-19? 

The ASE Statement on COVID-19 imaging can be found here: https://www.asecho.org/ase-statement-covid-19/  It states that cardiac ultrasound can be applied at the bedside to "screen for important cardiovascular findings, elucidate cardiac contributions to symptoms or signs, triage patients in need of full feature echocardiographic services and even, perhaps, identify early ventricular dysfunction during COVID-19 infection". Anecdotally, we have heard that huge numbers of cardiac echoes are being requested from the ER (80 requests/day is the experience of one well-known institution in NY) and bedside ultrasound is one method to triage these requests.

It seems that POCUS for triage assessment with nl SaO2 and no respiratory distress may screen for early “covid-like” findings,  but not change management while exposing equipment to disease. Can you comment?

We only advocate that ultrasound be used in a responsible fashion as part of a clinical exam. It is a tool that needs to be used when required. For patients who are clearly non-diseased or clearly very diseased, triage POCUS may not be indicated. POCUS can be more useful to screen the "middle third" of patients (typically referred to as “the grey zone”) who clinically are ambiguous.

Our CMO asked why POCUS should be used if nobody is getting admitted with dyspnea or hypoxia without a portable chest x-ray.  How would you counter or what are your thoughts on this?

Clinical evidence consistently suggests that lung ultrasound has a higher sensitivity than CXR in lung conditions such as pneumonia. Review this (https://butterflynetwork.com/case-studies/is-antibiotic-therapy-the-best-course-of-care) case study for more information.  

Will daily ultrasound track progress or resolution? 

Daily ultrasound can be used to track disease progress or resolution, as was demonstrated in real-time by Dr. Yale Tung Chen Emergency Medicine Hospital Universitario La Paz & COVID-19 Patient on twitter @yaletung