The stethoscope, a simple yet effective auscultation tool, was originally designed by French physician René Laennec in 1816 to assist him in auscultating the heart of a woman who he was particularly hesitant in using the traditional method, placing his ear to their chest. Aside from making health assessment slightly less awkward, the stethoscope has become a much-needed tool for all clinical personnel to assess chest sounds. MDs, RNs, RT, EMTs, paramedics, and many more use stethoscopes to assess heart and lung sounds to identify abnormalities better and treat patients. 

Eko Health [i.e., Eko] has developed tools to make listening from a stethoscope better and more purposeful. Since its founding in 2014 and FDA approval in 2015, Eko has been developing digital amplification and phonocardiogram (PCG) capabilities for traditional stethoscopes.

Eko kindly sent me one of their 3M™ Littmann® CORE Digital Stethoscopes to review and give my perspective on its use for nurses. While it was sent to me and I am being compensated, please know that all opinions are entirely my own and not influenced by these circumstances. I will go over unboxing, setup, usability, practicality, and my opinion. 

Unboxing 

The 3M™ Littmann® CORE Digital Stethoscope arrived in a standard 3M™ Littmann® Cardiology IV™ box with Eko branding. Upon unboxing, I immediately noticed it had the quality of that first Litttman many of us know as a graduation gift from nursing school. The Eko CORE digital attachment device is about an inch and a half from the dual head chest piece and feels solid and smooth to the touch, modest profile in black with a matte/eggshell finish. Other items in the box include a quick start guide booklet, a micro-USB charging cable, additional pair of small earpieces, and a band for the bell. This was all tucked away in form-fitting foam. 

App Setup

To immediately hear amplified heart and lung sounds, all that is needed is to turn the toggle bar on and start listening to the clicks and knocks of S1 and S2, or anything else you hear for that matter. To save recordings and observe the PCG, you’d have to pair the Eko CORE with the Eko App, which can be found in the App Store for iOS devices and the Google Play Store for Android devices. Download and create an Eko Health account with an email and password and modify the app to your preferences. For example, you can set the background connection time (when the app stays connected to the device), set a pin code to access the app, auto-omit patient identifiers upon sharing recordings, and set the recording length from 15 to 120 seconds. The saved recordings can also be accessed online via their web portal. Overall, the setup took me just over a minute, and I could record heart sounds instantly. 

Usability and Practicality

The overall weight of the stethoscope and Eko CORE device, combined with my measurement, was 7.4 ounces. Minimally heavier than the 6.2 ounce 3M™ Littmann® Cardiology IV™ Diagnostic Stethoscope alone. Wearing it over my shoulders and around my neck for an entire 12-hour shift taking off for breaks, and occasionally throughout patient care, I did not notice any neck pain or fatigue. If you like wearing your stethoscopes on a hip clip, the weight won’t pull down your scrub pants. It did feel balanced around my neck, not asymmetrically leaning to one side or the other. The battery lasts 8 hours on a full charge after 2.5 hours of charge time. The one I received arrived charged, I’ve used it for one entire shift and a lot on my own for this review, and I still haven’t needed to charge it. When it comes to charge, it’s easy to do with the provided micro-USB cable; you have to use your own power block (5V max) or even connect it to the USB-A  port on a computer to charge. 

To record and pair chest sounds, you have a few options depending on your intent; quick record and exam. For a quick heart, lung, and bowel sound recording, you place the stethoscope appropriately on the patient, tap record, and listen for the set record time. After recording, you can set a patient identifier and tag the site on the body. This would be helpful for teaching purposes or to assist your assessment report on rounds or shift changes. 

For a cardiac exam, you can spot-check by placing the chest piece on the left upper sternal border (LUSB) as indicated. The app will begin recording automatically upon recognizing the PCG. The AI then interprets and gives you one of three results: “No Murmur Detected,” “Murmur Detected,” or “Poor Quality PCG.” A poor quality PCG means better placement and pressure changes must be made. For a complete cardiac exam, you are prompted to record at the right upper sternal border (RUSB), the left upper sternal border (LUSB), the left lateral sternal border (LLSB), and the apex of the heart. As with a spot check, the Eko CORE begins recording the identification of a PCG signal. I noticed that user skill is still an important factor, as some patients were identified as having murmurs on some recordings and not on others while in the same position. I think it helps highlight the fact that currently, the AI software in the product is a screening tool and assistive device, not a diagnostic tool. 

Upon auscultating, you can toggle the digital filter for cardiac soundwaves, pulmonary soundwaves, or wide soundwaves. There is active noise cancellation in the software; in fact, while I was reviewing, there was a firmware update, and I did notice some improvements in the noise cancellation. While helpful, I noticed that as I auscultated in loud environments, the Eko CORE also amplified ambient noise. Not so much that it hindered an exam, but loud enough to notice and mention in a review. 

Opinion 

Which nurses could benefit from using the Eko CORE?

I think any nurse that works in a CVICU setting where cardiac abnormalities are more common and indicative of patient outcomes can benefit from the Eko CORE. For example, I imagine a scenario where a subtle pericardial friction rub is auscultated, amplified, and recorded by a nurse using the 3M™ Littmann® CORE Digital Stethoscope, who shares their findings with the team to help identify and treat pericarditis. 

Eko Health has Live streaming and telehealth software as well. For example, I can see a home health nurse who identifies cardiac or pulmonary changes in a patient that require physician notice. A recording can be sent or live-streamed to the medical team to begin treatment, potentially without sending the patient to the hospital.  

Should you buy the 3M™ Littmann® CORE Digital Stethoscope?

If you lose stethoscopes easily, as I do, I would not buy the 3M™ Littmann® CORE Digital Stethoscope unless you also invest in something like an Apple Tag. I wouldn’t buy it if you have phenomenal hearing and can identify abnormal heart and lung sounds with an educated ear. If you work in a high acuity setting with proper identification of abnormal heart and lung sounds is critical to intervention, then I would absolutely buy it. If you work in a rural, underserved, or home health setting and your assessments and screening are critical to connecting patients with a higher level of care, I would buy it. If you have trouble hearing heart, lung, or even bowel sounds in general, the Eko CORE will help you improve your assessments. 

Regardless of whether you buy it or not, the steps that Eko Health is taking in improving a long-trusted tool are the kind of advancements tech can offer healthcare. It doesn’t require us to change our processes; we don’t have to change what we do. We assess our patients, and Eko Health makes it easier to do with amplification and AI to assist.

This article is sponsored by Eko Health.