The paramedic ultrasound in cardiac arrest study

Objectives & Background The Edinburgh 3RU paramedicshave some advanced training in cardiac arrest (CA) managementThe PUCA study aimed to see whether pre-hospital paramedics canbe trained to perform and [2] interpret pre-hospital ELSretain ELS performance and interpretation skillsperform satisfactory pre-hospital ELSperform pre-hospital ELS without impacting CA careMethods Phase 1-Testing/purchasing a suitable ultrasoundmachinePhase 2-Formal classroom based training: one-day trainingcourse with practical and moulage sessions.Phase 3-Field based training.Phase 4-Prospective observational study of pre-hospital paramedicELS using saved ultrasound clips and wearable camera videos.Results During classroom based training, all paramedics couldobtain parasternal (PS) and subxiphoid (SX) images.88% of attempts in both views were successful in the pulse checkwindow.Theoretical knowledge improved (mean pre vs post course score54% vs 89%; p<0.001) and at 10 weeks was non-significantlyreduced (82%; p=0.13) but less so than practical performance(75% SX success, 25% PS success).By Sep 2015, 8 of 11 paramedics who attended initial training,had passed a triggered competency assessment and were practicing pre-hospital ELS independently.Between 23rd June 2014 and 31st Jan 2016, seven 3RU paramedics attended 45 patients suffering out-of-hospital CA whereresuscitation was attempted and the Venue 40 ultrasoundmachine was available and used.80% of first paramedic ELS attempts produced an adequate viewwhich was excellent/good/satisfactory in 68%.44% of views were obtained within the pulse check window witha median time off the chest of 17 seconds (IQR 13-20).A decision to perform ELS was communicated in 67% and thepulse check counted aloud in 60%.A manual pulse check was seen to be performed in a quarter ofpatients and the monitor rhythm checked in 38%.All decision changing scans involved a decision to stop resuscitation.Conclusion Paramedics can perform focussed ELS in the classroom, integrate attempts into simulated CA scenarios and retainsome of this knowledge.They obtain good ELS views in the pre-hospital environment butwith longer hands off the chest times.The quality of life support may be reduced with less obviouspulse and monitor checking.Paramedic pre-hospital ELS is more likely to be performed inpatients where discontinuation of resuscitation is being considered.Further training should focus on improving ELS situationalawareness.