Kreiser Michael A, Hill Brieanna, Karki Dikchhya, Wood Elke, Shelton Ryan, Peterson Jodi, Riccio John, Zapata Isain, Khalil Paul A, Gubler Dean, LaPorta Anthony J, Roosevelt Genie E, Toney Amanda G
Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA.
South Metro Fire and Rescue, Centennial, ColoradoUSA.
Prehosp Disaster Med. 2022 Feb;37(1):39-44. doi: 10.1017/S1049023X21001357. Epub 2022 Jan 7.
Paramedics received training in point-of-care ultrasound (POCUS) to assess for cardiac contractility during management of medical out-of-hospital cardiac arrest (OHCA). The primary outcome was the percentage of adequate POCUS video acquisition and accurate video interpretation during OHCA resuscitations. Secondary outcomes included POCUS impact on patient management and resuscitation protocol adherence.
A prospective, observational cohort study of paramedics was performed following a four-hour training session, which included a didactic lecture and hands-on POCUS instruction. The Prehospital Echocardiogram in Cardiac Arrest (PECA) protocol was developed and integrated into the resuscitation algorithm for medical non-shockable OHCA. The ultrasound (US) images were reviewed by a single POCUS expert investigator to determine the adequacy of the POCUS video acquisition and accuracy of the video interpretation. Change in patient management and resuscitation protocol adherence data, including end-tidal carbon dioxide (EtCO2) monitoring following advanced airway placement, adrenaline administration, and compression pauses under ten seconds, were queried from the prehospital electronic health record (EHR).
Captured images were deemed adequate in 42/49 (85.7%) scans and paramedic interpretation of sonography was accurate in 43/49 (87.7%) scans. The POCUS results altered patient management in 14/49 (28.6%) cases. Paramedics adhered to EtCO2 monitoring in 36/36 (100.0%) patients with an advanced airway, adrenaline administration for 38/38 (100.0%) patients, and compression pauses under ten seconds for 36/38 (94.7%) patients.
Paramedics were able to accurately obtain and interpret cardiac POCUS videos during medical OHCA while adhering to a resuscitation protocol. These findings suggest that POCUS can be effectively integrated into paramedic protocols for medical OHCA.
护理人员接受了床旁超声（POCUS）培训，以便在院外心脏骤停（OHCA）的医疗管理过程中评估心脏收缩功能。主要结局是OHCA复苏期间获得足够的POCUS视频并进行准确视频解读的百分比。次要结局包括POCUS对患者管理的影响以及对复苏方案的依从性。
在为期四小时的培训课程后，对护理人员进行了一项前瞻性观察队列研究，该培训课程包括理论讲座和POCUS实践指导。制定了心脏骤停院前超声心动图（PECA）方案，并将其纳入医疗不可电击OHCA的复苏算法中。由一名POCUS专家研究员对超声（US）图像进行审查，以确定POCUS视频采集的充分性以及视频解读的准确性。从院前电子健康记录（EHR）中查询患者管理和复苏方案依从性数据的变化，包括高级气道置入后的呼气末二氧化碳（EtCO2）监测、肾上腺素给药以及十秒内的按压中断情况。
在49次扫描中有42次（85.7%）采集的图像被认为是足够的，护理人员对超声检查的解读在49次扫描中有43次（87.7%）是准确的。POCUS结果在14/49（28.6%）的病例中改变了患者管理。护理人员在36/36（100.0%）有高级气道的患者中坚持进行EtCO2监测，在38/38（100.0%）的患者中给予肾上腺素，在36/38（94.7%）的患者中按压中断在十秒内。
护理人员能够在医疗OHCA期间准确获取并解读心脏POCUS视频，同时遵守复苏方案。这些发现表明POCUS可以有效地纳入医疗OHCA的护理人员方案中。
