Impact of Education for Paramedic-Performed Point-of-Care Ultrasound for Cardiac Function Evaluation: A Pilot Study Assessing Imaging Quality and Interpretation

Abstract

Background

Cardiac point-of-care ultrasound (cPoCUS) can detect occlusive myocardial infarction (OMI) in the absence of diagnostic electrocardiogram (ECG) by assessment of left ventricle (LV) function. The feasibility of cPoCUS to assess LV function in the prehospital setting is unknown.

Study Objective

To determine image adequacy and interpretation accuracy of paramedics performing cPoCUS for assessment of LV function and wall motion abnormality (WMA).

Methods

This was a prospective observation pilot study of ultrasound-naïve paramedics who participated in a clinical education program to identify OMI and performed cPoCUS during transport of adult patients. Primary outcomes were proportion of patients with 12-lead ECG who received cPoCUS, quality of images obtained, and paramedic interpretations (overall LV function and presence of a WMA). Sensitivity and specificity for LV function and WMA were calculated along with Cohen’s kappa (κ) comparing paramedic interpretation to ultrasound fellowship-trained emergency physicians.

Results

Of paramedics who passed a clinical evaluation (n = 14) and written test (n = 10), six opted to participate. Of the 201 eligible cases, 88.6% received cPoCUS during their transport to the hospital. Adequate views for LV function and WMA were obtained among 61.2% and 38.8% of patients, respectively. Accurate paramedic interpretations for LV function and WMA were made among 83/94 (88.3%) and 54/56 (96.4%) patients, respectively. There was moderate agreement between paramedics and physicians on LV function (κ = 0.41), with 41.7% sensitivity and 95.1% specificity. No patients presented with WMA.

Conclusion

With brief training, paramedics were able to acquire adequate cPoCUS images for LV function assessment, and interpretations were largely accurate.