Reshaping of Italian Echocardiographic Laboratories Activities during the Second Wave of COVID-19 Pandemic and Expectations for the Post-Pandemic Era
Authors: Ciampi Quirino , Antonini-Canterin Francesco , Barbieri Andrea , Barchitta Agata , Benedetto Frank , Cresti Alberto , Miceli Sofia , Monte Ines , Petrella Licia , Trocino Giuseppe , Aquila Iolanda , Barbati Giovanni , Barletta Valentina , Barone Daniele , Beraldi Monica , Bergandi Gianluigi , Bilardo Giuseppe , Boriani Giuseppe , Bossone Eduardo , Bongarzoni Amedeo , Bovolato Francesca , Bursi Francesca , Cammalleri Valeria , Carbonella Marco , Casavecchia Grazia , Cicco Sebastiano , Cioffi Giovanni , Cocchia Rosangela , Colonna Paolo , Cortigiani Lauro , Cucchini Umberto , D'Alfonso Maria , D’Andrea Antonello , Dell'Angela Luca , Dentamaro Ilaria , De Paolis Marcella , De Stefanis Paola , Deste Wanda , Di Fulvio Maria , Di Giannuario Giovanna , Di Lisi Daniela , Di Nora Concetta , Fabiani Iacopo , Esposito Roberta , Fazzari Fabio , Ferrara Luigi , Filice Gemma , Forno Davide , Giorgi Mauro , Giustiniano Enrico , Greco Cosimo , Iannuzzi Gian , Izzo Annibale , Lanzone Alberto , Malagoli Alessandro , Mantovani Francesca , Manuppelli Vincenzo , Mega Simona , Merli Elisa , Ministeri Margherita , Morrone Doralisa , Napoletano Cosimo , Nunziata Luigi , Pastorini Guido , Pedone Chiara , Petruccelli Enrica , Polito Maria , Polizzi Vincenzo , Prota Costantina , Rigo Fausto , Rivaben Dante , Saponara Silvio , Sciacqua Angela , Sartori Chiara , Scarabeo Virginia , Serra Walter , Severino Sergio , Spinelli Luciano , Tamborini Gloria , Tota Antonio , Villari Bruno , Carerj Scipione , Picano Eugenio , Pepi Mauro ,   SIECoVId Study Group, on Behalf of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
Published: August 2021

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.