The coronavirus pandemic caused by SARS-CoV-2 (COVID-19) has created new and unforeseen challenges for modern medicine and healthcare systems around the world. Since COVID-19 has direct and indirect effects on the cardiovascular system and cardiovascular patients are at risk of increased mortality from this disease, the work of cardiology departments has also been affected. Additionally, the fact that the severe acute respiratory syndrome caused by this virus is capable of airborne droplet human-to-human transmission has resulted in the need for special protection for medical and non-medical staff caring for these patients.

Echocardiography fellows and echocardiographic laboratories in Croatia have found themselves exposed to this sudden and unknown danger. Since echocardiography fellows are in close and extended contact with patients, they have increased risk of contracting the infection. Echocardiographic laboratories faced increased demands for echocardiography in critical patients and those suspected for COVID-19, which is understandable given that echocardiography is a basic cardiologic diagnostic procedure. In order to reduce the risk of transmitting the infection for patient to patient, from patient to echocardiography fellow, and vice-versa, it was necessary to carefully evaluate the indications for echocardiography and select only those that always effect the treatment and course of the disease.

The demanding and unprecedented conditions created by the pandemic, the limited number of trained echocardiography fellows available, and the risk of periprocedural transmission have become significant challenges in the organization of echocardiographic laboratories. As a result, the Working Group for Echocardiography and Imaging Modalities in Cardiology of the Croatian Cardiac Society has, based on the example of the EACVI guidelines (1), published a set of protocol recommendations for echocardiography during the COVID-19 pandemic (Figure 1 in Croatian, Figure 2) (2). The protocol, which is adapted to the specific conditions in Croatia, provides detailed recommendations on categorizing patients based on COVID-19 status, indications for echocardiography examinations, and protective measures for staff (personal protective equipment, organization of echocardiographic laboratories, choice and protection of devices). The greatest emphasis is placed on establishing the indications for an echocardiographic examination, which will remain topical even after the epidemic has subsided – an echocardiographic examination is indicated if it answers the crucial clinical question and if echocardiographic findings directly influence the course and/or outcome of patient treatment.

Core members of the Working Group for Echocardiography and Imaging Modalities in Cardiology of the Croatian Cardiac Society presented the protocol at the first web seminar titled “Echocardiography during the COVID-19 pandemic” that was held on April 30, 2020. During the web seminar, a previously recorded video was shown that presented detailed recommendations and instructions, after which representatives of regional centers exchanged their practical experiences with COVID-19 patients and organizing echocardiographic laboratories and had a live online discussion. The web seminars were received with great interesting and had a good response, so the first one was followed with five more web seminars under the overarching topic of “Echocardiography during the COVID-19 pandemic” that addressed the sub-topics “Pulmonary ultrasound” and “FoCUS echocardiography” (2). Educational video materials were made available on the “Armchair Echo” platform in order to make them accessible for on-demand viewing to as many physicians as possible (3).

The Working Group for Echocardiography and Imaging Modalities in Cardiology will continue to implement various educational projects, such as the multi-year “Echo on Wheels” project with in-person workshops, while also continuing the “Armchair Echo” project through web seminars available both live and on-demand from their educational platform.