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

Study Overview
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Brief Summary
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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
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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.

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

Conditions
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Circulatory Failure, Echocardiography

Intervention / Treatment
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* Procedure: Echocardiography


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Circulatory failure<br>Patients with a circulatory failure due to a sepsis or not | Procedure: Echocardiography<br>* Two-dimensional imaging echocardiography<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Agreement between emergency physician and referee physician echocardiography | Agreement between the measurements performed using two-dimensional imaging echocardiography by an emergency physician and the referring physician according to the following data : size of the left ventricle systolic function of the left ventricle size of the right ventricle dysfunction of the right ventricle size of the inferior vena cava pericardial effusion | Day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Agreement between emergency physicians and referring physician therapeutic propositions | Agreement between emergency physicians and referring physician therapeutic propositions according to the following choices: vascular filling define as a water volume of at least 500 mL vasopressor support positive inotropic therapy salt and water depletion | Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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echocardiography, training, emergency department, circulatory failure