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Introduction of an Extracorporeal Cardiopulmonary Resuscitation Eligibility Protocol for Paramedics in Atlantic
Colin P Rouse1, Jay Mekwan2, Paul Atkinson3
1Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, CAN.
Insights
An educational program significantly improved paramedics' ability to identify extracorporeal cardiopulmonary resuscitation (ECPR) candidates for out-of-hospital cardiac arrest (OHCA) patients. This training is crucial for timely transfers and potentially life-saving interventions.
Area of Science:
- Emergency Medicine
- Cardiology
- Paramedic Education
Background:
- Extracorporeal cardiopulmonary resuscitation (ECPR) is a novel intervention for out-of-hospital cardiac arrest (OHCA) not yet established in Atlantic Canada.
- Advanced care paramedics (ACPs) manage cardiac arrest pre-hospital, but ECPR is hospital-based, requiring accurate patient identification for transfer.
Purpose of the Study:
- To assess if an educational program can enhance paramedics' identification of suitable candidates for ECPR.
- To establish paramedic competence in selecting ECPR-eligible patients for rapid transfer.
Main Methods:
- A before-and-after study design utilized a case-based survey to evaluate paramedic knowledge.
- An educational intervention included a seminar, pocket card, and simulated OHCA cases.
- A Wilcoxon matched-pairs signed rank test compared pre- and post-education scores; qualitative data identified practical barriers.
Main Results:
- Paramedic scores significantly improved post-education, with median scores rising from 10 to 14 (p=0.0039).
- The educational program demonstrated a feasible method for knowledge translation regarding ECPR candidacy.
- Qualitative data provided insights for refining ECPR protocol inclusion/exclusion criteria.
Conclusions:
- Didactic sessions, pocket cards, and simulations effectively improved paramedic knowledge of ECPR candidate identification.
- The training approach appears feasible for knowledge translation in pre-hospital emergency care.
- Further follow-up will assess long-term knowledge retention for sustained competence.
Abstract:
Introduction There is currently no protocol for the initiation of extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest (OHCA) in Atlantic Canada. Advanced care paramedics (ACPs) perform advanced cardiac life support in the prehospital setting often completing the entire resuscitation on-scene. Implementation of ECPR will present a novel intervention that is only available at the receiving hospital. Our objective is to determine if an educational program can improve identification of ECPR candidates by paramedics. Establishing paramedic competence will ensure rapid transfer of eligible patients for a potentially life-saving intervention. Methods An educational program was delivered to paramedics including a short seminar and pocket card coupled with simulated OHCA cases. A before-and-after study design using a case-based survey was employed. Paramedics were scored on their ability to correctly identify patients suffering OHCA who met the inclusion criteria for our ECPR protocol. A Wilcoxon matched-pairs signed rank test was employed to compare paramedics' scores before and after the education delivery. A six-month follow-up is planned to assess retention. Qualitative data was also collected from paramedics during simulation to help identify practical issues, potential barriers, and to refine inclusion and exclusion criteria prior to the implementation of our protocol in the prehospital setting. Results The median score pre-education was 10 (IQR: 9-10.5) compared to 14 (IQR: 13-15) after education delivery. The median difference between groups was 5. The Wilcoxon matched-pairs test demonstrated a significant improvement in the paramedics' ability to correctly identify ECPR candidates after completing our educational program z = -2.67, p = 0.0039. Conclusion Paramedic training through a didactic session coupled with a pocket card and simulation appeared to be a feasible method of knowledge translation. Six-month follow-up data will help ensure knowledge retention is achieved.
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