Prehospital chest emergency sonography trial in Germany

Neeße, Albrecht; Jerrentrup, Andreas; Hoffmann, Saskia; Sattler, Alexander M.; Görg, Christian; Kill, Clemens; Gress, Thomas M.; Kunsch, Steffen

doi:10.1097/mej.0b013e328349edcc

Cited by 41 publications

(48 citation statements)

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“…Anyway it is not clear if the same efficacy can be exploited in the pre-hospital medical service for non-traumatic respiratory insufficiency [ 15 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lung evaluation is rapid and physicians can reach a reliable diagnosis in a few minutes [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…A rapid two-point technique (upper anterior and basal lateral areas) is usually enough to rule in or rule out an interstitial syndrome, a pneumothorax, or a pleural effusion [ 13 , 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, there are not many studies evaluating the real effectiveness of the pre-hospital lung ultrasound: Neesse et al [ 15 ] showed that the identification of a pleural effusion is useful for the differentiation between a cardiac heart failure (CHF) and an acute exacerbation of a chronic obstructive pulmonary disease (COPD). Strnad et al and Ferrari and collaborators suggested that lung ultrasound is reliable to monitor response to pre-hospital treatment with continuous positive airway pressure (CPAP) in patients with CHF [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Pre-hospital lung ultrasound for cardiac heart failure and COPD: is it worthwhile?

Zanatta¹,

Benato²,

Battisti³

et al. 2018

Crit Ultrasound J

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BackgroundPre-hospital ultrasound is a new challenge and lung ultrasound could be an interesting opportunity in the pre-hospital medical service. The aim of our study was to evaluate the efficacy of lung ultrasound in out-of-hospital non-traumatic respiratory insufficiency.MethodsWe planned a case-controlled study in the ULSS 5 ovest vicentino area (Vicenza—Italy) enrolling subjects with severe dyspnea caused by cardiac heart failure or acute exacerbation of chronic obstructive pulmonary disease. We compared drugs administration, oxygen delivery, and laboratory tests between those patients with ultrasound integrated management and those without ultrasound.ResultsPre-hospital lung ultrasound had a high specificity (94.4%) and sensitivity (100%) for the correct identification of alveolar interstitial syndrome using B lines, whereas the percentages obtained with pleural effusion were lower (83.3, 53.3%, respectively). The patients with ultrasound integrated management received a more appropriate pharmacological therapy (p 0.01), as well as non-invasive ventilation (CPAP) was used more frequently in those with an acute exacerbation of chronic obstructive pulmonary disease (p 0.011). Laboratory tests and blood gases analysis were not significant different between the two study groups. In a sub-analysis of the patients with an A profile, we observed a significant lower concentration of PCO2 in those with an ultrasound integrated management (PCO2: 42.62 vs 52.23 p 0.049). According with physicians’ opinion, pre-hospital lung ultrasound gave important information or changed the therapy in the 42.3% of cases, whereas it just confirmed physical examination in the 67.7% of cases.ConclusionsPre-hospital lung ultrasound is easy and feasible, and learning curve is rapid. Our study suggests that cardiac heart failure and acute exacerbation of chronic obstructive pulmonary disease can be considered two indications for pre-hospital ultrasound, and can improve the management of patient with acute respiratory insufficiency.

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“…Anyway it is not clear if the same efficacy can be exploited in the pre-hospital medical service for non-traumatic respiratory insufficiency [ 15 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lung evaluation is rapid and physicians can reach a reliable diagnosis in a few minutes [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pre-hospital lung ultrasound for cardiac heart failure and COPD: is it worthwhile?

Zanatta¹,

Benato²,

Battisti³

et al. 2018

Crit Ultrasound J

View full text Add to dashboard Cite

show abstract

“…Prior reports have found novel applications for sonography in prehospital patients with acute dyspnoea, demonstrating high sensitivity for pleural effusions in patients with CHF 18. In the future, combining sonography with capnography may provide a method for determining appropriate treatment in the field.…”

Section: Discussionmentioning

confidence: 99%

Prehospital end-tidal carbon dioxide differentiates between cardiac and obstructive causes of dyspnoea

et al. 2014

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Background Differentiating between cardiac and obstructive causes for dyspnoea is essential for proper management, but is difficult in the prehospital setting. Objective To assess if prehospital levels of end-tidal carbon dioxide (ETCO2) differed in obstructive compared to cardiac causes of dyspnoea, and could suggest one diagnosis over the other. Methods We conducted a retrospective cohort study among patients transported by emergency medical services during a 29-month period who were diagnosed with either obstructive pulmonary disease or congestive heart failure (CHF) by ICD-9 codes. Initial prehospital vital signs, including ETCO2, were recorded. Records were linked by manual archiving of emergency medical services and hospital data. Results There were 106 patients with a diagnosis of obstructive or cardiac causes of dyspnoea that had prehospital ETCO2 levels measured during the study period. ETCO2 was significantly lower in patients diagnosed with CHF (31 mm Hg 95% CI 27 to 35) versus obstructive pulmonary disease (39 mm Hg 95% CI 35 to 42; p<0.001). Lower ETCO2 levels predicted CHF, with an area under the Receiver Operating Characteristics Curve of 0.70 (95% CI 0.60 to 0.81). Using ETCO2 <40 mm Hg as a cut-off, the sensitivity for predicting heart failure was 93% (95% CI 88% to 98%), the specificity was 43% (95% CI 33% to 52%), the positive predictive value was 38% (95% CI 29% to 48%), and the negative predictive value was 94% (95% CI 89% to 99%). Conclusions Lower levels of ETCO2 were associated with CHF, and may serve as an objective diagnostic adjunct to predict this cause of dyspnoea in the prehospital setting.

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Respiratory distress

Oost¹,

Daya²

2015

Emergency Medical Services

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Prehospital chest emergency sonography trial in Germany

Cited by 41 publications

References 0 publications

Pre-hospital lung ultrasound for cardiac heart failure and COPD: is it worthwhile?

Pre-hospital lung ultrasound for cardiac heart failure and COPD: is it worthwhile?

Prehospital end-tidal carbon dioxide differentiates between cardiac and obstructive causes of dyspnoea

Respiratory distress

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