• Arthur Lieveld, M L A Heldeweg, J M Smit, M E Haaksma, L Veldhuis, R S Walburgh-Schmidt, J Twisk, NanayakkaraP W BPWBAcute Internal Medicine, Amsterdam UMC, Location VUmc, the Netherlands., L Heunks, and P R Tuinman.
• Acute Internal Medicine, Amsterdam UMC, Location VUmc, the Netherlands; Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location VUmc, the Netherlands.. Electronic address: a.lieveld@amsterdamumc.nl.
• J Crit Care. 2022 Jun 1; 69: 153992153992.

PurposeCritically ill COVID-19 patients have an increased risk of developing pulmonary embolism (PE). Diagnosis of PE by point-of-care ultrasound (POCUS) might reduce the need for computed tomography pulmonary angiography (CTPA), while decreasing time-to-diagnosis.Materials & MethodsThis prospective, observational study included adult ICU patients with COVID-19. Multi-organ (lungs, deep vein, cardiac) POCUS was performed within 24 h of CTPA, looking for subpleural consolidations, deep venous thrombosis (DVT), and right ventricular strain (RVS). We reported the scan time, and calculated diagnostic accuracy measures for these signs separately and in combination.Results70 consecutive patients were included. 23 patients (32.8%) had a PE. Median scan time was 14 min (IQR 11-17). Subpleural consolidations' diagnostic accuracy was: 42.9% (95%CI [34.1-52.0]). DVT's and RVS' diagnostic accuracy was: 75.6% (95%CI [67.1-82.9]) and 74.4% (95%CI [65.8-81.8]). Their sensitivity was: 24.0% (95%CI [9.4-45.1]), and 40.0% (95%CI [21.3-61.3]), while their specificity was: 88.8% (95%CI [80.8-94.3]), and: 83.0% (95%CI [74.2-89.8]), respectively. Multi-organ POCUS sensitivity was: 87.5% (95%CI [67.6-97.3]), and specificity was: 25% (95%CI [16.9-34.7]).ConclusionsMulti-organ rather than single-organ POCUS can be of aid in ruling out PE in critically ill COVID-19 and help select patients for CTPA. In addition, finding RVS can make PE more likely, while a DVT would preclude the need for a CTPA.Registrationwww.trialregister.nl: NL8540.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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