Paramedic Echocardiography in Pulseless Electrical Activity Cardiac Arrest: An Education and Simulation Study

Area of Science:

• Emergency medicine
• Point-of-care ultrasound (POCUS)
• Paramedic practice

Background:

• Relying solely on manual pulse checks for pulseless electrical activity (PEA) in out-of-hospital cardiac arrest (OHCA) may lead to suboptimal care.
• Ultrasound integration into emergency medical services (EMS) offers potential for rapid diagnosis.

Purpose of the Study:

• To evaluate if paramedics, with minimal training, can obtain and interpret ultrasound images within a 10-second window during simulated cardiac arrest.
• To assess the quality of acquired ultrasound images and the retention of interpretation skills.

Main Methods:

• Thirty paramedics underwent e-learning and face-to-face training on cardiac arrest ultrasound.
• Participants performed simulated cardiac arrest scenarios, acquiring ultrasound images within a 10-second pulse check pause.
• Image quality was assessed using the Cardiac Ultrasound Structural Assessment Score (CUSAS); interpretation accuracy was recorded.

Main Results:

• Paramedics acquired ultrasound scans in an average of 9.6 seconds, with 47% completed within the 10-second pause.
• 73% of acquired scans met the criteria for adequate image quality (CUSAS ≥ 3).
• Paramedics demonstrated high interpretation accuracy, correctly identifying 91% of pathological scans.

Conclusions:

• Paramedics can effectively acquire and interpret ultrasound images during simulated cardiac arrest within the critical 10-second pulse check timeframe.
• Point-of-care ultrasound is a feasible tool for paramedics managing OHCA, potentially improving diagnostic accuracy and patient outcomes.