Taylor Benjamin, Joshi Bhushan, Hutchison Leanne, Manivel Vijay
Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia.
The University of Sydney, Sydney, NSW 2000, Australia.
Resusc Plus. 2020 Nov 27;4:100047. doi: 10.1016/j.resplu.2020.100047. eCollection 2020 Dec.
Focused echocardiography during peri-shock pause (PSP) can prognosticate and detect reversible causes in cardiac arrest but minimising interruptions to chest compressions improves outcome. The COACH-RED protocol was adapted from the COACHED protocol to systematically incorporate echocardiography into rhythm check without prolonging PSP beyond the recommended 10 s. The primary objective of this study was to test the feasibility of emergency nurses learning to perform all roles in the COACH-RED protocol. PSP duration and change in participant confidence were secondary outcomes.
After an initial two-hour workshop, five ALS-trained nurses were assessed for the correct use of COACH-RED protocol, without critical error, in three simulated cardiac arrest scenarios of four cycles each. Assessments were repeated on days 7 and 35. On day 35, three COACHED scenarios were also assessed for comparison. Participant roles per scenario and cardiac rhythm per cycle were randomised. Participants completed questionnaires on their confidence levels. Sessions were videotaped for accurate measurement of PSP duration and results tabulated for simple comparison. Statistical analysis was not performed due to small sample size.
There were no critical errors, two minor team-leading errors and two minor echosonography errors. Minor errors occurred in separate scenarios resulting in a 100% pass rate overall by predetermined criteria. Echocardiographic recordings were 100% adequate. Overall median PSP was 9.35 s for COACH-RED and 6.94 s for COACHED. Sub-group analysis of COACH-RED revealed median PSP 10.80 s in shockable rhythms and 8.74 s (∼2 s less) in non-shockable rhythms. Mean participant confidence in performing COACH-RED improved from 1.6 to 4.6, on a 5-point scale.
The COACH-RED protocol can be effectively performed by ALS-trained nurses, in all roles of this protocol, including echocardiography, in a simulated environment, after a single training session. Using this protocol, focused echocardiography does not prolong PSP beyond 10 s.
在休克暂停期（PSP）进行聚焦超声心动图检查可对心脏骤停进行预后评估并检测可逆病因，但尽量减少胸外按压的中断可改善预后。COACH-RED方案改编自COACHED方案，旨在将超声心动图系统地纳入节律检查中，同时不使PSP超过推荐的10秒。本研究的主要目的是测试急诊护士学习执行COACH-RED方案中所有角色的可行性。PSP持续时间和参与者信心的变化为次要结果。
在最初为期两小时的工作坊后，对五名接受过高级生命支持（ALS）培训的护士进行评估，看其在三个模拟心脏骤停场景（每个场景四个周期）中能否正确使用COACH-RED方案且无严重错误。在第7天和第35天重复评估。在第35天，还对三个COACHED场景进行评估以作比较。每个场景的参与者角色和每个周期的心律均随机分配。参与者完成关于其信心水平的问卷。对 sessions 进行录像以准确测量PSP持续时间，并将结果列表以便于简单比较。由于样本量小，未进行统计分析。
无严重错误，有两个轻微的团队领导错误和两个轻微的超声心动图错误。轻微错误发生在不同场景中，根据预定标准总体通过率为100%。超声心动图记录的充分率为100%。COACH-RED方案的总体PSP中位数为9.35秒，COACHED方案为6.94秒。对COACH-RED方案的亚组分析显示，可电击心律时的PSP中位数为10.80秒，不可电击心律时为8.74秒（少约2秒）。参与者执行COACH-RED方案的平均信心从1.6提高到了4.6（满分5分）。
经过单次培训后，接受过ALS培训的护士能够在模拟环境中有效地执行COACH-RED方案的所有角色，包括超声心动图检查。使用该方案时，聚焦超声心动图不会使PSP延长超过10秒。
