Diagnostic Performance of Echocardiography Performed by Emergency Physicians After a Basic Training

NCT ID: NCT02974790

Last Updated: 2018-03-29

Basic Information

• Recruitment Status: TERMINATED
• Total Enrollment: 89 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2017-01-02
• Study Completion Date: 2018-03-02

Brief Summary

After a basic training to echocardiography, emergency physicians will have to answer simple clinical questions about circulatory failure mechanisms. The objective of the study is to assess the agreement between these answers and those of the expert physician in patients admitted in the emergency department with a circulatory failure due to sepsis or not. Emergency physicians will volunteer to take part in a basic training on echocardiography. The training will include 4 hours of theory, 2 hours of interactive clinical cases and 6 hours of tutored practice at patients' bedside (10 to 15 examinations). The objective of the practice sessions will be to learn the technical grounds of transthoracic echocardiography (TTE), the different views and to identify the anatomical structures. The second part of the study will start after the training. Each eligible patient will be successively assessed by two investigators: one emergency physician recently trained and the expert physician. The echocardiography will be performed as soon as possible in the emergency department before or after the initiation of treatment without delaying it. The order of hemodynamic assessments will be random depending on the availability of the investigators; both assessments will however be performed within 30 minutes. Each investigator will independently read the echocardiography in real time at patients' bedside. They will then answer a limited list of standardized questions using two-choice answers or predefined choices. Finally investigators will choose a therapeutic proposition among a predefined list based on the answers. Only the results of the echocardiography performed by the expert physician will be used in patient management.

Detailed Description

After a basic training to echocardiography, emergency physicians will have to answer simple clinical questions about circulatory failure mechanisms. The objective of the study is to assess the agreement between these answers and those of the expert physician in patients admitted in the emergency department with a circulatory failure due to sepsis or not. Emergency physicians will volunteer to take part in a basic training on echocardiography. The training will include 4 hours of theory, 2 hours of interactive clinical cases and 6 hours of tutored practice at patients' bedside (10 to 15 examinations). The objective of the practice sessions will be to learn the technical grounds of transthoracic echocardiography (TTE), the different views and to identify the anatomical structures. The second part of the study will start after the training. Each eligible patient will be successively assessed by two investigators: one emergency physician recently trained and the expert physician. The echocardiography will be performed as soon as possible in the emergency department before or after the initiation of treatment without delaying it. The order of hemodynamic assessments will be random depending on the availability of the investigators; both assessments will however be performed within 30 minutes. Each investigator will independently read the echocardiography in real time at patients' bedside. They will then answer a limited list of standardized questions using two-choice answers or predefined choices. Finally investigators will choose a therapeutic proposition among a predefined list based on the answers. Only the results of the echocardiography performed by the expert physician will be used in patient management.

Conditions

Circulatory Failure; Echocardiography

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Circulatory failure

Patients with a circulatory failure due to a sepsis or not

Echocardiography

Intervention Type: PROCEDURE

Two-dimensional imaging echocardiography

Interventions

Echocardiography

Two-dimensional imaging echocardiography

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• patients > 18 years old
• patients admitted in the Emergency Department of Limoges University Hospital
• patients with circulatory failure defined as 1 or more of the following criteria :
• clinical signs of tissue hypoperfusion
• mottling
• Encephalopathy
• Oliguria < 0.5 ml/kg/h
• biological signs of hypoperfusion
• Lactate > 2 mmol/L
• AND/OR Low blood pressure defined as a sBP < 90 mmHg or mBP < 65 mmHG or decrease of sBP > 40 mmHg compared with usual blood pressure
• OR Patients with signs of sepsis recently defined as the following :
• Suspicion of clinical infection
• At least 2 of the 3 following items (i.e. SOFA > 2 points with 1 point/item) :
• Glasgow score < 13
• Respiratory rate > 22 cycle/min
• Systolic blood pressure < 100 mmHg

Exclusion Criteria

• Pregnant patients
• Moribund patients or with limited care
• Patients under legal protection

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University Hospital, Tours

OTHER

Sponsor Role: collaborator

University Hospital, Limoges

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Limoges University Hospital

Limoges, , France

Countries

France

Other Identifiers

I16035 (ECHOBEDSIDE)

Identifier Type: -

Identifier Source: org_study_id