Congestive Heart Failure(CHF), Pulmonary Edema
Conditions
Keywords
Ultrasound, Emergency Medical Services, Pulmonary Ultrasound, Pulmonary Edema, Congestive Heart Failure, Paramedic
Brief summary
The goal of this prospective nonrandomized study is to determine if prehospital lung ultrasound findings result in a change in patient management. This study will look at how lung ultrasound exam improves diagnosis of respiratory distress in patients being treated by Emergency Medical Services, such as patients with heart failure. Additional questions include: * How well can paramedics obtain and interpret ultrasound images? * How does ultrasound use change treatment received by patients? * How does ultrasound use impact patient outcomes? Participants will receive a lung ultrasound exam, but otherwise receive standard evaluation and care. Patients who receive ultrasound will be compared to those who did not receive ultrasound for logistical reasons and patients from before the use of ultrasound. Ultrasound will not be withheld from any patient for the purposes of the study.
Interventions
DIAGNOSTIC_TESTPulmonary ultrasound
Ultrasound of up to six lung zones (1, 2, and 4) will be obtained. Paramedics will assess for the presence of B lines.
Sponsors
Rutgers, The State University of New Jersey
Christiana Care Health Services
Cooper University Health Care
Hackensack Meridian Health
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient treated by Emergency Medical Services * Complaint of dyspnea At least one of the following: * Oxygen saturation \<94% on room air * Abnormal lung sounds * Increased work of breathing * Pedal edema * Orthopnea
Exclusion criteria
* Pediatric patients (\<18) * Traumatic etiology * Cardiac arrest at any point prehospitally * No ultrasound-trained paramedic involved in patient's care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency with which prehospital lung ultrasound findings result in a change in patient management by EMS | From time of patient encounter to patient handoff at the hospital. (anticipated average of one hour) | Frequency of management changes will be compared from before prehospital ultrasound was used to after prehospital ultrasound has been implemented. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Survival to discharge | At time of hospital discharge (anticipated average one week) | — |
| Percent of prehospital diagnoses agreeing with hospital diagnosis | At time of hospital discharge (anticipated average of one week) | Diagnostic accuracy |
| Whether or not patient is intubated by EMS or during hospital admission, recorded as yes or no | EMS patient encounter to hospital discharge (anticipated average one week) | — |
| Days on ventilator or non-invasive ventilation | Hospital arrival to hospital discharge (anticipated average one week) | — |
| Length of stay | Hospital arrival to hospital discharge (anticipated average one week) | — |
| Length of ICU stay | Hospital admission to hospital discharge (anticipated average one week) | — |
| Paramedic ultrasound interpretation accuracy | Enrollment | Comparison between paramedic interpretation (of presence of lung sliding and number of B lines) with physician interpretation |
| Quality of ultrasound obtained by paramedic | Enrollment | Rating of ultrasound using a five-point scale (1 being no recognizable structures, 5 being criteria met for diagnosis, all structures imaged with excellent image quality and diagnosis completely supported) by physician |
Countries
United States
Contacts
CONTACTElizabeth Blizzard
CONTACTAndrew Grandin
PRINCIPAL_INVESTIGATORDanielle Levine, MD
Christiana Care Health Services
PRINCIPAL_INVESTIGATORStephen Carroll, DO, MEd
Christiana Care Health Services
PRINCIPAL_INVESTIGATORTung-Lin Yuan, DO
Rutgers University
Outcome results
None listed