Paramedic Echocardiography in Pulseless Electrical Activity Cardiac Arrest: An Education and Simulation Study
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Latta, Hannah
Swain, Andrew
Garrett, Nick
Tunnage, Bronwyn
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Wiley
Abstract
BACKGROUND: Patients presenting with pulseless electrical activity (PEA) in out-of-hospital cardiac arrest (OHCA) may receive inappropriate care if a manual pulse check is relied upon to determine pulselessness. This study aimed to investigate whether ultrasound-naïve paramedics could acquire an ultrasound image within a 10-s pause during a pulse check in a simulated cardiac arrest environment and interpret ultrasound-detectable pathology. Secondary aims focus on the quality of ultrasound image acquisition and the retention of learned knowledge.
METHOD: Thirty paramedics participated in three sequential phases. Phase I involved a self-directed e-learning program covering an overview of ultrasound applications, including cultural considerations for indigenous New Zealand Māori in cardiac arrest. Phase II included face-to-face education, simulation assessments, and a knowledge quiz. Phase III included simulation assessments and a knowledge quiz. Ultrasound images were scored against the cardiac ultrasound structural assessment score (CUSAS) for quality.
RESULTS: During simulated cardiac arrest scenarios, the mean time to acquire an ultrasound scan was 9.6 s (SD = 2.9, 95% CI [9.3, 10.0]). Forty-seven per cent of study scans were captured within the 10-s pulse check pause. Of the acquired images, 73% (95% CI [67.8, 79.4]) of scans scored a CUSAS of ≥ 3, demonstrating adequate image quality. Participants correctly interpreted 91% (95% CI [88.5, 94.5]) of 243 pathological scans during the simulations. In Phase II, 83 of 87 interpretations were correct (95%, 95% CI [91.0, 99.7]), while in Phase III, 140 of 156 interpretations were correct (90%, 95% CI [84.9, 94.4]).
CONCLUSIONS: During cardiac arrest simulations, paramedics on average took 9.6 s to acquire an ultrasound scan, with 47% of scans completed within the 10-s pulse-check pause. RESEARCH AIMS: To determine if paramedics can acquire an ultrasound image within the 10-s pulse check pause in simulated pulseless electrical activity (PEA) cardiac arrest. Secondary aims focus on the quality of ultrasound image acquisition, interpretation and retention of learned knowledge.
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EMS, New Zealand, POCUS, cardiac arrest, out‐of‐hospital, paramedic, prehospital, pulseless electrical activity, ultrasound, ultrasound image quality, 32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, Biomedical Imaging, Bioengineering, Heart Disease, Cardiovascular, 4.1 Discovery and preclinical testing of markers and technologies, 1103 Clinical Sciences, 3202 Clinical sciences
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Australasian Journal of Ultrasound in Medicine, ISSN: 1836-6864 (Print); 2205-0140 (Online), Wiley, 29(1), e70032-e70032. doi: 10.1002/ajum.70032
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This is the Author's Accepted Manuscript of an article published in the Australasian Journal of Ultrasound in Medicine © 2025 Australasian Society for Ultrasound in Medicine. The final, published version is available at (see Publisher's version).