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

Mirko Zanatta,Piero Benato,Sigilfredo De Battisti,Concetta Pirozzi,Vito Cianci,Renato Ippolito

doi:10.1186/s13089-018-0104-5

Abstract

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.

Highlights

Pre-hospital ultrasound is a new challenge and lung ultrasound could be an interesting opportunity in the pre-hospital medical service
The primary and secondary outcomes of our work evaluated the efficacy of lung ultrasound in out-of-hospital non-traumatic respiratory insufficiency, by analyzing clinical and laboratory parameters after the arrival at the emergency department
We recruited 30 patients affected by non-traumatic respiratory insufficiency caused by cardiac heart failure (CHF) (12 patients) or acute exacerbation of chronic obstructive pulmonary disease (COPD) (18 patients), who underwent an ultrasound integrated management (US group) and were compared with 30 patients managed without ultrasound (NUS group)

Summary

Introduction

Pre-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. The lung ultrasound has changed significantly in-hospital management of non-traumatic respiratory insufficiency, and it could be a new and interesting opportunity in the pre-hospital setting with a few and clear indications: the determination of the lung profile (A: no signs of increased extravascular lung water—“dry lung”; B: increased extravascular lung water—“wet lung”), the identification of pleural effusions, and the diagnosis of pneumothorax [2, 13]. Lung evaluation is rapid and physicians can reach a reliable diagnosis in a few minutes [13–15]

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