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Point-of-Care Ultrasound Use by EMS Providers in Out-of-Hospital Cardiac Arrest

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  07 January 2022

Michael A. Kreiser Open the ORCID record for Michael A. Kreiser [Opens in a new window] ,
Brieanna Hill ,
Dikchhya Karki ,
Elke Wood ,
Ryan Shelton ,
Jodi Peterson ,
John Riccio ,
Isain Zapata ,
Paul A. Khalil Open the ORCID record for Paul A. Khalil [Opens in a new window]  and
Dean Gubler
...Show all authors
Michael A. Kreiser*
Affiliation:
Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA
Brieanna Hill
Affiliation:
Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA
Dikchhya Karki
Affiliation:
Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA
Elke Wood
Affiliation:
Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA
Ryan Shelton
Affiliation:
Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA South Metro Fire and Rescue, Centennial, ColoradoUSA
Jodi Peterson
Affiliation:
Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA South Metro Fire and Rescue, Centennial, ColoradoUSA
John Riccio
Affiliation:
South Metro Fire and Rescue, Centennial, ColoradoUSA Centura Prehospital Services, Centennial, ColoradoUSA
Isain Zapata
Affiliation:
Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA
Paul A. Khalil
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, KentuckyUSA Norton Children’s Hospital, Louisville, KentuckyUSA
Dean Gubler
Affiliation:
Department of Military Medicine, Rocky Vista University College of Osteopathic Medicine – Southern Utah Campus, Ivins, UtahUSA
Anthony J. LaPorta
Affiliation:
Department of Military Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA
Genie E. Roosevelt
Affiliation:
Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, ColoradoUSA
Amanda G. Toney
Affiliation:
Rocky Vista University College of Osteopathic Medicine, Parker, ColoradoUSA Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, ColoradoUSA
*
Correspondence: Michael Kreiser, BS, Rocky Vista University, College of Osteopathic Medicine, 8401 S Chambers Rd, Parker, Colorado 80134 USA, E-mail: michael.kreiser@rvu.edu
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Abstract

Aim:

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.

Methods:

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).

Results:

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.

Conclusion:

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.

Keywords

cardiacparamedicPOCUSprehospitalresuscitation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 1 , February 2022 , pp. 39 - 44
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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