BCG Biosensor and Non- and Invasive Monitoring During Emergency Medicine Cases, a Prospective Feasibility Study

NCT ID: NCT04891380

Last Updated: 2024-04-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 183 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-05-18
• Study Completion Date: 2024-01-03

Brief Summary

In a out of hospital emergency medicine study the investigators will measure hemodynamic effects of implemented treatments for patients with cardiac arrest, hypotension, and intensive care transports. The investigators will use both non-invasive and invasive measuring technology to measure this. Ballistocardiographic biosensors are introduced together with more advanced non-invasive and invasive measurements such as invasive arterial blood pressure with cardiac output calculation and saturation cerebral tissue oxygenation (SctO2). During treatment of cardiac arrest patients the investigators will use a new LUCAS 2 Active Decompression device (LUCAS 2 AD2) and measure different hemodynamic variables.

Detailed Description

Pre-hospital monitoring of vital signs has documented to increase survival. Especially advanced multi-monitoring units have shown to have this impact but they are demanding in use. Low blood pressure/blood flow are frequent in emergency medicine cases and diagnosed by combining clinical evaluation (breathing, circulation, neurology) with biosensor measures of vital signs. Examples of biosensors are ECG, Ballistocardiographic (BCG), End Tidal CO2 (EtCO2), pulse oximetry (SpO2), saturation cerebral tissue oximetry (SctO2), transthoracic impedance (TTI), and invasive arterial pressure measurements such as pulse contour analysis for cardiac output measures. The gold standard for blood flow measurement is cardiac output [Cardiac Output (CO), volume of blood pumped by the heart pr. minute as the product of stroke volume (SV) and heart rate]. Cardiac output may be measured by invasive (thermodilution, Fick method) or noninvasively techniques [oesophageal Doppler, transoesophageal echocardiography, lithium dilatation cardiac output, pulse contour cardiac output (PICCO, Pulse Cardiac Output system, FloTrac ™), partial CO2 rebreathing, thoracic electrical bioimpedance. Pulse contour analysis is based on that the area under the systolic part of the arterial pressure waveform is proportional to the stroke volume (SV). This may limit the optimal goal for monitoring adequately several emergency medicine cases. There is, therefore, a need to develop and evaluate biosensor devices in these situations. BCG biosensors have been introduced and have documented to be useful in monitoring noninvasively vital signs but they have not been used in acute emergency medicine. It has been documented a correlation (r2=0.85) between BCG biosensor and cardiac output measured by Doppler echocardiogram. The biosensor record very subtle rhythmic movements on the patient skin (abdomen and/or neck) and shows a graph which is presented based on filters and custom-made algorithms as continuous hemodynamic variables (heart- and respiration-rates, heart rate variability, and relative stroke volume). BCG piezoelectric biosensors (BGPS) are easy to put on the patient, non-invasive, light (grams), small (2 x 2 cm), and costs are low. They support live streaming with automatic downloads of data. For most other measuring devices this must be done manually post event. With limited time of education and training all personnel prehospitally can deploy the biosensor over the carotid or abdominal aorta. Based on pilots and a validation study comparing two BCG biosensors (accelerometer and piezoelectric) with measures performed by present clinical practise the piezoelectric biosensor is best for use in situations where measures must be instant. In the same validation study, the investigators documented that pulse contour analysis with the latest software upgrade of FloTrac™ system worked well compared with Doppler echocardiography (manuscript in progress, ClinTrialGov). Studies have validated the efficacy of FloTrac ™ with pulmonary artery catheter and found different results. A review article concluded that FloTrac ™ has the possibility to increase patient safety in relation to perioperative hemodynamic monitoring. A comparison of simultaneous Stroke Volume (SV) and Cardiac Output measurements by echocardiography and FloTrac ™ were done in ten mechanically ventilated intensive care patients and showed a correlation between them (SV, y = 0.9545x + 3.3, R2 = 0.98 and for CO, y = 0.9104x + 7.7074, R² = 0.97). Therefore, it is indicated to use this biosensor for out of hospital cases. Although pulse contour analysis is an invasive method, the investigators have experience with invasive arterial access in the doctor car that respond to emergency cases in Oslo since invasive monitoring is the standard.

In a pre-hospital observational study performed by the doctor manned car (119-unit) in Oslo and Akershus, the investigators will compare and document (correlations, sensitivities, specificities) biosensor measures to current gold standard measures during cardiopulmonary resuscitation (CPR), hypotension, and intensive care transports. This challenges the current practice because most pre-hospital units responding to emergency medicine cases do not have alternatives to advanced measures. Therefore, the patient is not monitored well enough in addition to that they seldom receive instant guidance according to the effect of treatment. The investigators approach is novel and innovative since it has never been done but the investigators study group have recent experience with performing similar advanced clinical monitoring studies prehospitally. There is a potential that more pre-hospital units will deliver better monitoring and care to more patients with these non- and invasive approaches. Ultimately, better healthcare will be provided.

The data captured for the cardiac arrest patients will be compared with data from NCT02479152.

If the current project is successful, the investigators plan to implement this technology in a larger scale and may then be able to study potentially improved survival and morbidity rates with sufficient statistical power in future studies.

Conditions

Cardiac Arrest, Out-Of-Hospital; Hypotension and Shock

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Cardiac arrest patients

Cardiac arrest patients receiving cardiopulmonary resuscitation with LUCAS 2 Active Decompression 2.

Group Type: OTHER

LUCAS 2 Active Decompression 2

Intervention Type: DEVICE

Chest compression with active decompression of the chest. Measurement of physiological parameters.

Hypotension

Patients developed or may develope hypotension of non traumatic origin.

Group Type: OTHER

Hypotension

Intervention Type: OTHER

measurement of physiological parameters

Intensive care patient transport

Patients who are transported from one intensive department to another.

Group Type: OTHER

Intensive care transport

Intervention Type: OTHER

Measurement of physiological parameters

LUCAS 2 Active Decompression

The hemodynamic measurements of the cardiac arrest patients in the present study will be compared with the hemodynamic measurements achieved in the previous study NCT02479152.

Group Type: OTHER

LUCAS 2 Active Decompression 2

Intervention Type: DEVICE

Chest compression with active decompression of the chest. Measurement of physiological parameters.

Interventions

LUCAS 2 Active Decompression 2

Chest compression with active decompression of the chest. Measurement of physiological parameters.

Intervention Type: DEVICE

Hypotension

measurement of physiological parameters

Intervention Type: OTHER

Intensive care transport

Measurement of physiological parameters

Intervention Type: OTHER

Other Intervention Names

FloTrac ™; BCG; Cerebral oximetry

Eligibility Criteria

Inclusion Criteria

• Non-traumatic cardiac arrest, hypotension, intensive care transport where an attempt of resuscitation and treatment is considered appropriate in patients age ≥18 years.

Exclusion Criteria

• Age <18 years.

• Traumatic cardiac arrest
• Known pregnancy (can be included in the hypotension group)
• Victim not to be resuscitated (DNR orders)
• Internals in prison
• Included once in the study already
• Patients too small for LUCAS 2-AD2 < 18.5 cm chest height
• Patient too big for LUCAS 2-AD2 > 27.3 cm chest height
• Chest or upper abdomen surgery (Large scars on the chest, only in the CPR group.
• Sustained Restoration Of Spontaneous Circulation (ROSC) occurring before the LUCAS 2-AD2 can be applied to the patient, such that further CPR is not needed

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

Sponsors

Norwegian Telemedicine

UNKNOWN

Sponsor Role: collaborator

Kopera Norway

UNKNOWN

Sponsor Role: collaborator

Edwards Medical

UNKNOWN

Sponsor Role: collaborator

Stryker Medical

INDUSTRY

Sponsor Role: collaborator

University of Bilbao

UNKNOWN

Sponsor Role: collaborator

University of Stavanger

OTHER

Sponsor Role: collaborator

Oslo University Hospital

OTHER

Sponsor Role: lead

Responsible Party

Lars Wik

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Lars Wik, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Oslo University Hospital

Locations

Oslo University Hospital

Oslo, Please Select, Norway

Countries

Norway

Other Identifiers

205218

Identifier Type: -

Identifier Source: org_study_id