Ability of non-physicians to perform and interpret lung ultrasound: A systematic review

• Published in: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2019-08, Vol.18 (6), p.474-483
• Main Authors: Swamy, Varsha, Brainin, Philip, Biering-Sørensen, Tor, Platz, Elke
• Format: Article
• Language: English
• Subjects: Allied Health Personnel; Clinical Competence; Emergency Medical Technicians; Heart failure; Heart Failure - complications; Heart Failure - nursing; Humans; Investigations; Lung Diseases - diagnostic imaging; Lung Diseases - etiology; Medical students; Nurses; Paramedics; Point-of-Care Systems; Sensitivity and Specificity; Students; Systematic review; Ultrasonic imaging; Ultrasonography
• ISSN: 1474-5151; 1873-1953
• DOI: 10.1177/1474515119845972

Background: Lung ultrasound is a useful tool in the assessment of pulmonary congestion in heart failure that is typically performed and interpreted by physicians at the point-of-care. Aims: To investigate the ability of nurses, students, and paramedics to accurately identify B-lines and pleural effusions for the detection of pulmonary congestion in heart failure and to examine the training necessary. Methods and results: We conducted a systematic review and searched online databases for studies that investigated the ability of nurses, students, and paramedics to perform lung ultrasound and detect B-lines and pleural effusions. Of 979 studies identified, 14 met our inclusion criteria: five in nurses, eight in students, and one in paramedics. After 0–12 h of didactic training and 58–62 practice lung ultrasound examinations, nurses were able to identify B-lines and pleural effusions with a sensitivity of 79–98% and a specificity of 70–99%. In image adequacy studies, medical students with 2–9 h of training were able to acquire adequate images for B-lines and pleural effusions in 50–100%. Only one eligible study investigated paramedic-performed lung ultrasound which did not support the ability of paramedics to adequately acquire and interpret lung ultrasound images after 2 h of training. Conclusions: Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases. The examination of heart failure patients with lung ultrasound by non-clinicians appears feasible and warrants further investigation.