Rapid assessment of hearth and lung with a smartphone size hand held ultrasound machine in critical patients to enhance and complement the pysical examination

Transthoracic high-end standard echocardiography (SE) is an integral part of cardiologic critical patient (pts) assessment. The newest generation of smartphone-size hand held ultrasound devices (echoPod) enables bedside TTE with 2D imaging and colour-Doppler. The aim of the present preliminary study was to evaluate the diagnostic value of echoPod in critical cardiologic pts. Methods. 132 consecutive pts (64 STEMI, 44 NSTEMI, 4 pericardial effusion, 6 pulmonary embolism, 10 arrhythmias, 4 intra-aortic balloon pump counterpulsated shocks) immediately after admitted in ICCU underwent examinations with a echoPod (VSCAN). Within 2 hours 20 pts underwent SE to compare the diagnostic ability of echoPod in critically ill patients. Target parameters were global systolic left-ventricular function (LVF, normal >55% or severely-impaired <30%), identification of marked right and/or left ventricular enlargement (RVE, LVE, yes/no), identification of left wall motion abnormalities LWMA), presence of severe valvular regurgitation (sev REG, yes/no), evidence of pericardial effusion (PE yes/no), of pleural effusion (PluE yes/no) and identification of comets lung (CL, yes/no). Results. 100% concordance was found in semi-quantitative assessment of LVF, RVE, LVE, PE, PluE, CL. Good concordance (>95%) was found for identification of sevREG. LWMA were correctly identified by echoPod with a sensitivity of 78% (95%CI 0.4-0.98) and a specificity of 100% (95% CI 0.89-1). Conclusion. A smartphone-size hand held ultrasound device permits reliable and quick assessment of RV and LV dimension and function. Largest differences were found for identification of LWMA. Severe Regurgitations and pericardial effusion can be well identified by echoPod too. Besides the echoPod can be also used in lung analysis particularly in pleural effusion and “comets” detection. An echoPod exam does not replace the standard echocardiographic exam, but can provide a rapid bedside pre-assessment which may help to improve patient management and to optimize the individual diagnostic work-flow in several clinical scenario like emergency room or ambulance for example.