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

Published online by Cambridge University Press:  07 January 2022

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: [email protected]

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.

Type
Original Research
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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References

McNally, B, Robb, R, Mehta, M, et al. Out-of-hospital cardiac arrest surveillance – Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005-December 31, 2010. MMWR Surveill Summ. 2011;60(8):119.Google Scholar
Sasson, C, Rogers, MA, Dahl, J, Kellermann, AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3(1):6381.10.1161/CIRCOUTCOMES.109.889576CrossRefGoogle ScholarPubMed
Abrams, HC, McNally, B, Ong, M, Moyer, PH, Dyer, KS. A composite model of survival from out-of-hospital cardiac arrest using the Cardiac Arrest Registry to Enhance Survival (CARES). Resuscitation. 2013;84(8):10931098.CrossRefGoogle Scholar
Larsen, MP, Eisenberg, MS, Cummins, RO, Hallstrom, AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med. 1993;22(11):16521658.CrossRefGoogle ScholarPubMed
Panchal, AR, Bartos, JA, Cabanas, JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S366S468.CrossRefGoogle ScholarPubMed
Eberle, B, Dick, WF, Schneider, T, Wisser, G, Doetsch, S, Tzanova, I. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation. 1996;33(2):107116.10.1016/S0300-9572(96)01016-7CrossRefGoogle ScholarPubMed
Dick, WF, Eberle, B, Wisser, G, Schneider, T. The carotid pulse check revisited: what if there is no pulse? Crit Care Med. 2000;28(11 Suppl):N183185.CrossRefGoogle ScholarPubMed
Fukuda, T, Ohashi-Fukuda, N, Matsubara, T, Gunshin, M, Kondo, Y, Yahagi, N. Effect of prehospital epinephrine on out-of-hospital cardiac arrest: a report from the national out-of-hospital cardiac arrest data registry in Japan, 2011-2012. Eur J Clin Pharmacol. 2016;72(10):12551264.10.1007/s00228-016-2093-2CrossRefGoogle Scholar
Breitkreutz, R, Price, S, Steiger, HV, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010;81(11):15271533.10.1016/j.resuscitation.2010.07.013CrossRefGoogle ScholarPubMed
Ultrasound Guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2017;69(5):e27-e54.CrossRefGoogle Scholar
Simard, RD, Unger, AG, Betz, M, Wu, A, Chenkin, J. The POCUS pulse check: a case series on a novel method for determining the presence of a pulse using point-of-care ultrasound. J Emerg Med. 2019;56(6):674679.CrossRefGoogle ScholarPubMed
Badra, K, Coutin, A, Simard, R, Pinto, R, Lee, JS, Chenkin, J. The POCUS pulse check: a randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound. Resuscitation. 2019;139:1723.CrossRefGoogle ScholarPubMed
Gaspari, R, Weekes, A, Adhikari, S, et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation. 2016;109:3339.CrossRefGoogle ScholarPubMed
Taylor, J, McLaughlin, K, McRae, A, Lang, E, Anton, A. Use of prehospital ultrasound in North America: a survey of emergency medical services medical directors. BMC Emerg Med. 2014;14:6.10.1186/1471-227X-14-6CrossRefGoogle ScholarPubMed
Fitzgibbon, JB, Lovallo, E, Escajeda, J, Radomski, MA, Martin-Gill, C. Feasibility of out-of-hospital cardiac arrest ultrasound by EMS physicians. Prehosp Emerg Care. 2019;23(3):297303.10.1080/10903127.2018.1518505CrossRefGoogle ScholarPubMed
Scharonow, M, Weilbach, C. Prehospital point-of-care emergency ultrasound: a cohort study. Scand J Trauma Resusc Emerg Med. 2018;26(1):49.CrossRefGoogle ScholarPubMed
Ketelaars, R, Beekers, C, Van Geffen, GJ, Scheffer, GJ, Hoogerwerf, N. Prehospital echocardiography during resuscitation impacts treatment in a physician-staffed helicopter Emergency Medical Service: an observational study. Prehosp Emerg Care. 2018;22(4):406413.CrossRefGoogle Scholar
Chin, EJ, Chan, CH, Mortazavi, R, et al. A pilot study examining the viability of a Prehospital Assessment with UltraSound for Emergencies (PAUSE) protocol. J Emerg Med. 2013;44(1):142149.10.1016/j.jemermed.2012.02.032CrossRefGoogle ScholarPubMed
Bhat, SR, Johnson, DA, Pierog, JE, Zaia, BE, Williams, SR, Gharahbaghian, L. Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): point-of-care ultrasound in Emergency Medical Services. West J Emerg Med. 2015;16(4):503509.10.5811/westjem.2015.5.25414CrossRefGoogle ScholarPubMed
Reed, MJ, Gibson, L, Dewar, A, Short, S, Black, P, Clegg, GR. Introduction of paramedic led echo in life support into the prehospital environment: the PUCA study. Resuscitation. 2017;112:6569.10.1016/j.resuscitation.2016.09.003CrossRefGoogle ScholarPubMed
Rooney, KP, Lahham, S, Lahham, S, et al. Prehospital assessment with ultrasound in emergencies: implementation in the field. World J Emerg Med. 2016;7(2):117123.10.5847/wjem.j.1920-8642.2016.02.006CrossRefGoogle ScholarPubMed
Directors DMEM. Denver Metropolitan Prehospital Protocols. http://www.dmemsmd.org/sites/default/files/DMEMSMD-Protocols-2020-07-01.pdf. Accessed 2020.Google Scholar
Butterfly Network. Information Security Compliance and Testing. https://support.butterflynetwork.com/hc/en-us/articles/360028021351-Information-Security-Compliance-Testing. Accessed May 9, 2021.Google Scholar
Cheskes, S, Schmicker, RH, Christenson, J, et al. Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation. 2011;124(1):5866.10.1161/CIRCULATIONAHA.110.010736CrossRefGoogle ScholarPubMed
Huis In’t Veld, MA, Allison, MG, Bostick, DS, et al. Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation. 2017;119:9598.10.1016/j.resuscitation.2017.07.021CrossRefGoogle Scholar
Clattenburg, EJ, Wroe, P, Brown, S, et al. Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: a prospective cohort study. Resuscitation. 2018;122:6568.10.1016/j.resuscitation.2017.11.056CrossRefGoogle ScholarPubMed
Hayhurst, C, Lebus, C, Atkinson, PR, et al. An evaluation of echo in life support (ELS): is it feasible? What does it add? Emerg Med J. 2011;28(2):119121.CrossRefGoogle ScholarPubMed
Clattenburg, EJ, Wroe, PC, Gardner, K, et al. Implementation of the Cardiac Arrest Sonographic Assessment (CASA) protocol for patients with cardiac arrest is associated with shorter CPR pulse checks. Resuscitation. 2018;131:6973.10.1016/j.resuscitation.2018.07.030CrossRefGoogle ScholarPubMed
Gardner, KF, Clattenburg, EJ, Wroe, P, Singh, A, Mantuani, D, Nagdev, A. The Cardiac Arrest Sonographic Assessment (CASA) exam - a standardized approach to the use of ultrasound in PEA. Am J Emerg Med. 2018;36(4):729731.CrossRefGoogle Scholar
Kedan, I, Ciozda, W, Palatinus, JA, Palatinus, HN, Kimchi, A. Prognostic value of point-of-care ultrasound during cardiac arrest: a systematic review. Cardiovasc Ultrasound. 2020;18(1):1.10.1186/s12947-020-0185-8CrossRefGoogle ScholarPubMed
Botker, MT, Jacobsen, L, Rudolph, SS, Knudsen, L. The role of point of care ultrasound in prehospital critical care: a systematic review. Scand J Trauma Resusc Emerg Med. 2018;26(1):51.CrossRefGoogle ScholarPubMed
Long, B, Alerhand, S, Maliel, K, Koyfman, A. Echocardiography in cardiac arrest: an emergency medicine review. Am J Emerg Med. 2018;36(3):488493.10.1016/j.ajem.2017.12.031CrossRefGoogle Scholar
O’Dochartaigh, D, Douma, M, MacKenzie, M. Five-year retrospective review of physician and non-physician performed ultrasound in a Canadian critical care helicopter Emergency Medical Service. Prehosp Emerg Care. 2017;21(1):2431.10.1080/10903127.2016.1204036CrossRefGoogle Scholar
Mehta, C, Brady, W. Pulseless electrical activity in cardiac arrest: electrocardiographic presentations and management considerations based on the electrocardiogram. Am J Emerg Med. 2012;30(1):236239.10.1016/j.ajem.2010.08.017CrossRefGoogle ScholarPubMed
Wu, C, Zheng, Z, Jiang, L, et al. The predictive value of bedside ultrasound to restore spontaneous circulation in patients with pulseless electrical activity: a systematic review and meta-analysis. PLoS One. 2018;13(1):e0191636.CrossRefGoogle ScholarPubMed
Engdahl, J, Bang, A, Lindqvist, J, Herlitz, J. Factors affecting short- and long-term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity. Resuscitation. 2001;51(1):1725.CrossRefGoogle Scholar
Rabjohns, J, Quan, T, Boniface, K, Pourmand, A. Pseudo-pulseless electrical activity in the emergency department, an evidence-based approach. Am J Emerg Med. 2020;38(2):371375.10.1016/j.ajem.2019.158503CrossRefGoogle ScholarPubMed
Gaspari, R, Weekes, A, Adhikari, S, et al. A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON study. Resuscitation. 2017;120:103107.CrossRefGoogle ScholarPubMed
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