This multicentre, cluster-randomised, stepped-wedge clinical trial aims to assess whether an intervention designed to implement an ultrasound-guided pre-hospital care pathway for the management of acute dyspnea would improve the effectiveness and efficiency of the mobile emergency medical service (SMUR) compared with standard care.
The order in which centres switch to the intervention (use of ultrasound) will be randomized. The study will begin with an initial 2-month period during which no centre will use ultrasound (standard care). Thereafter, two centers will switch to the intervention phase, and every two months, a further two centres will in turn move into the intervention phase. By the end of the study, all centres will have used ultrasound for at least 2 months.
A total of 800 adults patients treated for acute dyspnea by the SMUR and meeting the inclusion criteria will be enrolled. Each patient's management will be determined by the study phase in effect at their centre at the time of enrolment (control phase without ultrasound or intervention phase with ultrasound).
The appropriateness of treatments administered during SMUR interventions will be compared between the period with ultrasound (intervention phase) and the period without ultrasound (control pahse).
Patient ≥ 18 years olds
Patients with non-traumatic acute dyspnea requiring intervention and management by an emergency medical services team
Patient receiving oxygen during emergency medical services treatment
Patients affiliated with a social security system
Patient for whom the reason for intervention is chest pain or shock
Patient with impaired consciousness requiring immediate intubation
Patients under guardianship, trusteeship or legal protection
Patients deprived of their liberty by judicial or administrative decision, persons undergoing psychiatric care
Parallel
Ultrasound pre-hospital care
Diagnostic testUse of Ultrasound to guide pre-hospital care for the management of acute dyspnea by the Mobile Emergency Medical Service (SMUR).
Score for appropriate treatments administered during the prehospital emergency medical team (SMUR) intervention.
1\) This outcome ranges from 0 to 1 (0 = completely inappropriate treatment; 1 = appropriate and effective/minimal treatment). 2) This outcome requires a review of the final diagnosis of acute dyspnea cases treated by the SMUR, as well as an assessment of whether each treatment administered in the SMUR ambulance was appropriate. This review will be conducted by a multidisciplinary team without knowledge of the randomization group.
Clinical factors evaluated: diagnosis made in the SMUR ambulance, considered to be consistent with the final diagnosis upon admission.
Clinical factors evaluated: all-cause mortality.
Clinical factors evaluated: readmission for acute dyspnea (following the comittee's decision).
Clinical factors evaluated: consultations with general practitioners.
Number of consultations with general practitioners.
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Central Hospital, Nancy, France
Lead sponsor
Direction Générale de l'Offre de Soins
Collaborator
This trial is not recruiting at the moment. You can still explore other options:
