Elsevier

Resuscitation

Volume 81, Issue 11, November 2010, Pages 1534-1539
Resuscitation

Clinical paper
Peri-resuscitation echocardiography: Training the novice practitioner

https://doi.org/10.1016/j.resuscitation.2010.07.001Get rights and content

Abstract

Aims

Echocardiography performed in an ALS-compliant manner provides a tool whereby some of the potentially reversible causes of cardiac arrest can be diagnosed in real time by minimally trained practitioners. One of the major concerns this raises is how to deliver effective training to the required standard. The objective of this study was to determine the effectiveness of number of different educational methods used teach echocardiography to novices. This involved assessment of cognitive, psychomotor skills and affective aspects in five key areas.

Methods

The study population was a convenience sample from participants attending standardised structured one-day training courses in peri-resuscitation echocardiography (n = 204). Subjects were assessed for five learning outcomes including knowledge and image interpretation, practical performance of echocardiography including time taken to obtain a diagnostic view, integration into the ALS algorithm and overall compliance with established resuscitation guidelines.

Results

There was a significant improvement in knowledge and interpretation of echocardiographic images before and after completion of the one-day course (pre 62%, post 78%, p < 0.01). Skills acquisition resulted in 100% of participants being able to obtain a subcostal view of diagnostic quality by the end of the course, and 86% with a mean time to acquisition of <10 s. On completion of the training programme, incorporation of echocardiography into current resuscitation practice did not compromise ALS-compliance.

Conclusion

Novice echocardiographers can obtain knowledge and skills relevant to ALS-compliant peri-resuscitation echocardiography using a range of educational techniques. In addition to the standard one-day training courses available, continued mentored practice and didactic adherence to ALS algorithms is required.

Introduction

Successful resuscitation demands that the cause for cardiac arrest be reversible and diagnosed in a timely manner. Echocardiography performed in an ALS-compliant manner provides a tool whereby some of the potentially reversible causes of cardiac arrest can be diagnosed in real time by the bedside1 and can inform subsequent management/therapeutic interventions (Table 1). One of the major concerns regarding the performance of echocardiography by novice practitioners in the resuscitation setting is how to deliver effective training to the required standard. Although there is extensive literature regarding the effectiveness of training in resuscitation, there is little in the literature regarding the processes of educating novice focused echocardiographers.2, 3 In comparison to other forms of emergency/focused ultrasound imaging echocardiography is unique in requiring knowledge and understanding of anatomy and physiology, and interpretation within the immediate clinical context. The objective of this study was to determine the effectiveness of educational methods used within training courses designed to teach echocardiography to novices. This involved evaluation of learning in cognitive (knowledge), psychomotor and affective domains in five areas required for ALS-compliant peri-resuscitation echocardiography (knowledge and image interpretation, practical performance, time-limitation, integration into ALS algorithm and ALS-compliance).

Section snippets

Methods

For each evaluation the study population was a convenience sample from participants attending a standardised one-day training courses for novice echocardiographers. Each course complied with standard peri-resuscitation echocardiography course content,4 although there were some slight variations in delivery to due local logistics. Written consent was obtained from all course participants for their inclusion in the study and for publication of anonymised results. Participants (n = 204) were all

Results

There was a significant improvement in knowledge gain, and interpretation of echocardiographic images before and after completion of the course (p < 0.01, Fig. 1). Following one day of training, participants were successful in obtaining images of diagnostic quality (as judged by an expert echocardiographer) more than 90% of the time except for the parasternal short axis and apical 2-chamber views (87% and 76% respectively). 100% of participants were able to obtain a subcostal view of diagnostic

Discussion

Echocardiography is a challenging skill to master, covering all three learning domains, requiring knowledge for correct image interpretation and diagnosis, practical image acquisition (psychomotor) skills and affective skills in order to usefully integrate focused echocardiography into clinical practice. Previous studies have demonstrated that focused echocardiography can be performed by novice practitioners with minimal training.5, 6 This study demonstrates that within a structured one-day

Limitations

A potential limitation of this study is that it was not a randomised controlled study (challenging in educational research) but relied on convenience sampling. The selection of groups for assessment was performed randomly, with no information provided to the students prior to the course regarding which aspect would be assessed. Students were not selected on the basis of volunteering to participate in assessment, and no students refused to participate. It is unlikely therefore that the results

Conclusion

Novice echocardiographers can learn the knowledge and skills relevant to ALS-compliant peri-resuscitation echocardiography using a range of educational techniques. However, in addition to the standard one-day training programmes available, continued mentored practice and didactic adherence to ALS algorithms is required to achieve and maintain individual competence.

Conflict of interest statement

There are no conflicts of interest, or financial/industry support to declare.

Acknowledgements

We are obliged to the Frankfurt Fire Department (D. Oberndörfer, V. Wilken, H. Pfleger, O. Haller, B. Jantke) and Prof. Leo Latasch, chief of prehospital EMS of the city of Frankfurt am Main. Following colleagues were generously participating in data acquisition or advised in planning or execution of the study: U. Hannemann, M. Haas. The assistance of T. Kunz and C. Cuca is gratefully acknowledged.

We thank Lt. Col. G. Lübke, Col. Dr. M. Benker, Bundeswehrkrankenhaus, Berlin and Col. Dr. M.

References (14)

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    After a prospective study43 that looked at the outcomes of resuscitation of patients in whom treatable causes were detected in a number of patients who would have otherwise been declared as having pulseless electrical activity, the panel has considered training in this context as important. Other publications by the same group142,244 concluded that novice cardiac ultrasound performers could obtain knowledge and skills relevant to ALS-compliant periresuscitation echocardiography using a range of educational techniques, including 1-day courses. The participants felt strongly that making the above statement would not be premature and that incorporating such training in the courses would constitute as a strong recommendation.

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    See Video 22 for an example of a subcostal view to evaluate for the presence of cardiac function. When cardiac ultrasound shows no ventricular activity and there is asystole on the cardiac monitor after full ACLS resuscitative attempts by paramedics, survival is rare.39,47,48 Other signs of failure of resuscitation include the development of coagulating blood and isolated atrial and valve movement without organized ventricular activity.40

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.07.001.

1

These authors contributed equally to this work.

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