• Can paramedics perform and evaluate a focused echocardiogram during a simulated 10-second pulse check, after a one-day training course?

      Younger, Paul; Richards, Simon; Jarman, Robert (2016-12)
      Abstract published with permission. Aim ‐ To assess whether paramedics can be trained to perform basic echocardiograms in the 10-second pulse check window during a simulated advanced life support (ALS) resuscitation. Introduction ‐ Cardiac arrest survival in the UK varies between 2% and 12%. Management of cardiac arrests concentrates on the detection of reversible causes, which is limited pre-hospitally due to a lack of equipment. Ultrasound machines are now small enough for pre-hospital use and may assist in the detection of some of these causes. There is currently no evidence to suggest the best methodology or required course duration to train paramedics to use ultrasound, or to indicate whether ultrasound simulation could be beneficial. Methods ‐ Ten volunteer paramedics were trained to perform focused echocardiograms using handheld ultrasounds and an ultrasound simulator. The training involved six hours of teaching and practical training, at the end of which the participants were assessed using objective structured clinical examinations (OSCEs) on an ultrasound simulator with three different pathologies which were relevant in cardiac arrest management. Results ‐ Paramedics were able to get a view of the heart during the assessments in 96.7% of the OSCEs, but were only able to accurately recognise the pathologies of the condition in 50%. Overall, the participants demonstrated simulated competence in 46.7% of the OSCEs. Conclusion ‐ Paramedics can be trained to gain a view of the heart using focused echocardiograms after a one-day course, but are not consistently able to determine the cardiac activity or pathology from the echocardiogram.
    • Comparison of manual and mechanical cardiopulmonary resuscitation on the move using a manikin: a service evaluation

      Blair, Laura; Kendal, Simon Peter; Shaw, Gary; Byers, Sonia; Dew, Rosie; Norton, Michael; Wilkes, Scott; Wright, John (2017-12)
      Abstract published with permission. Aim: The aim of this study was to assess the effect that transporting a patient has on the quality of cardiopulmonary resuscitation (CPR) provided during pre-hospital resuscitation. Utilising the 2010 European Resuscitation Council (ERC) guidelines as a framework, one- and two-person manual CPR (SCPR) and mechanical CPR (MCPR) were directly compared in a simulated pre-hospital transport setting. Methods: Ten practising paramedics each volunteered to participate in four pre-hospital CPR scenarios. The MCPR device used for this study was the LUCASTM2. Data were captured electronically using QCPRTM wireless technology (Resusci Anne® Wireless SkillReporterTM manikin and software by Laerdal Medical©). Results: A reduction in the rate, depth and percentage of correct compressions was noted when the paramedics were moving the patient. In relation to the 2010 ERC guidelines, the SCPR did not meet current guidelines and was of more variable quality than MCPR. MCPR was consistent and conformed to the guidelines. However, the application of the LUCASTM2 when only one paramedic was present resulted in a significant delay in commencing chest compressions. Conclusion: In the pre-hospital setting, transporting a patient during a cardiac arrest can have a deleterious effect on the quality of chest compressions being provided. When provided by a mechanical device rather than manually, the quality of chest compressions produced is closer to that currently recommended, but two persons would be required for timely deployment of the device and to maximise the chest compression fraction. This could suggest a potential use for pre-hospital MCPR even in the absence of recommendation for routine use.
    • A service evaluation of a dedicated pre-hospital cardiac arrest response unit in the North East of England

      McClelland, Graham; Younger, Paul; Haworth, Daniel; Gospel, Amy; Aitken-Fell, Paul (2016-09)
      Abstract published with permission. Aim ‐ This article describes the introduction of a specialist cardiac arrest response unit by the North East Ambulance Service NHS Foundation Trust, with the aim of improving treatment and outcomes of out-of-hospital cardiac arrest patients, in the North East of England. Methods ‐ This study is a retrospective analysis of prospectively collected data, describing all cases where the cardiac arrest response unit was dispatched in the first 12 months of operation (January 2014 to January 2015). Results ‐ The cardiac arrest response unit was activated 333 times during the first year of operation and attended 164 out-of-hospital cardiac arrest patients. The cardiac arrest response unit demonstrated a significant impact on return of spontaneous circulation sustained to hospital (OR 1.74 (95% CI 1.19‐2.54), p = 0.004) and survival to discharge (OR 2.08 (95% CI 1.12‐3.84), p = 0.017) compared with the rest of the North East Ambulance Service NHS Foundation Trust. Conclusion ‐ The cardiac arrest response unit project demonstrated an improvement in return of spontaneous circulation and survival to discharge compared to current standard care. The specific mechanism, or mechanisms, by which the cardiac arrest response unit influences patient outcomes remain to be determined.