Use of Point-of-Care Ultrasonography in Simulation-Based Advanced Cardiac Life Support Scenarios

Abstract

Background: Ultrasonography is an effective tool for diagnosing potential reversible aetiologies of cardiac arrest. We developed an educational curriculum for critical care ultrasonography involving multiple sequential cardiac arrest simulation scenarios and assessed the efficacy of participants’ performance. Methods: Didactic lectures and hands-on training sessions were provided before participants were divided into simulation teams for a series of five scenarios in which they were instructed to utilize ultrasonography during ongoing advanced cardiac life support (ACLS). Simulation sessions were videotaped and subsequently reviewed for extraction of parameters relating to ACLS adherence and performance of point-of-care ultrasonography examination. The primary outcome was duration of no-flow interval (NFI), the period during which chest compressions are halted and ultrasound examination is typically performed.  We also collected data on NFI score (based on simulation team performance during NFI), time from arrest to first chest compressions, time from arrest to defibrillation, and other parameters describing team performance. Results: Fifty-five course participants comprised 12 simulation teams.  For all participants, the average NFI was 22.2 s (95% CI, 19.1-25.2) during scenario 1, with declines in duration thereafter (P ≤ 0.004). In subsequent scenarios, an increasing proportion of NFI occurred within the interval of 10 s (P = 0.018).   Conclusion: Simulation is an effective teaching modality for critical care ultrasonography. Novice ultrasound users can be taught to perform point-of-care ultrasonography effectively during simulated cardiopulmonary arrest in an ACLS-compliant manner, a finding that may have significant implications for the clinical management of in-hospital cardiac arrest. (Funded by the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, and Johns Hopkins Medicine Simulation Center.)     Citation: Stephanie Cha, Allan Gottschalk, Erik Su, Adam Schiavi, Adam Dodson, Aliaksei Pustavoitau. Use of Point-of-Care Ultrasonography in Simulation-Based Advanced Cardiac Life Support Scenarios. J Anesth Perioper Med 2017; 4 : x- xx. doi: 10.24015/ JAPM.2017.0058 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.