Dyspnea and Biomarkers in a Prehospital Setting
Dyspnea and Biomarkers in a Prehospital Setting
In patients presenting with acute dyspnea in a pre-hospital setting, the early and correct
 diagnosis may present a significant clinical challenge. Physical examination, chest
 radiography, electrocardiography, and standard biological tests often fail to accurately
 differentiate heart failure (HF) from pulmonary causes of dyspnea. Timely differentiation of
 HF from other causes of dyspnea may permit the early institution of appropriate medical
 therapy. Brain natriuretic peptide (BNP) and amino-terminal pro-brain natriuretic peptide
 (NT-proBNP) have been proposed as early markers of HF and demonstrated to be useful for
 diagnosing and excluding HF in the emergency department. A combination of BNP or NT-proBNP
 testing and standard clinical assessment has been suggested to be superior to either tool
 used in isolation. Some previous studies have also suggested that quantitative capnometry
 (QC) may be useful in differentiating between cardiac and obstructive causes of respiratory
 distress. Therefore, the investigators hypothesized that a new combination of NT-proBNP
 testing, standard clinical assessment, and partial pressure of end-tidal CO2 (PetCO2) would
 optimize evaluation and differentiation of acute dyspnea in a pre-hospital setting.

 The aim of this study was to determine the accuracy of combination of QC, NT-proBNP, and
 clinical assessment in differentiating acute HF from obstructive pulmonary disease
 (COPD/asthma) as a cause of acute dyspnea in pre-hospital emergency setting.
Inclusion Criteria:

 -  patient had to present with shortness of breath as the primary complaint (defined as
 either the sudden onset of dyspnea without history of chronic dyspnea or an increase
 in the severity of chronic dyspnea)

 Exclusion Criteria:

 -  age <18 years

 -  history of renal insufficiency, trauma, severe coronary ischemia (unless patient's
 predominant presentation was dyspnea), and other causes of dyspnea:

 -  pneumonia

 -  pulmonary embolism

 -  carcinoma

 -  pneumothorax

 -  pleural effusion

 -  intoxications (drugs)

 -  anaphylactic reactions

 -  upper airway obstruction

 -  bronchial stenosis

 -  gastroesophageal reflux disorder

 -  according to the history, clinical status, and additional laboratory tests available
 in pre-hospital setting (D-dimer, troponin, C-reactive protein)