To the Editor,
The International Liaison Committee on Resuscitation (ILCOR) published updated guidelines for Advanced Life Support (ALS).
1The structured ALS provider course is designed to help disseminate the knowledge and enhance the skills of health professionals in the early recognition and intervention of cardiac arrest, acute coronary syndromes, respiratory distress, and shock.
- Soar J.
- Berg K.B.
- Andersen L.W.
- et al.
Adult advanced life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
Resuscitation. 2020; 156: A80-A119
- Nolan J.P.
Advanced life support training.
Resuscitation. 2001; 50: 9-11
Ultrasound (US) is an increasingly used diagnostic tool in emergency and critical care settings, as an integral part of resuscitation and other critical scenarios. Several protocols such as RUSH, BLUE, and US-CAB were introduced in recent years.
- Perera P.
- Mailhot T.
- Riley D.
- Mandavia D.
The RUSH exam: rapid ultrasound in SHock in the evaluation of the critically ill.
Emerg Med Clin North Am. 2010; 28: 29-56
- Lichtenstein D.A.
BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.
Chest. 2015; 147: 1659-1670
5Besides the traditional methods such as auscultation, electrocardiogram, capnography, and chest radiography, the US probe is the extension of the doctor’s hand to look inside the patient. Therefore, we proposed echo-assisted life support (eALS) curriculum building on the current ALS provider course (Supplementary file 1). It included 3 important critical scenarios: cardiac arrest, chest pain/dyspnea, and shock in which the US-CAB protocol, the RUSH protocol, and the cardiac assessment plus the BLUE protocol (Fig. 1) were adopted respectively. The teaching lessons were determined and standardized by the consensus of the experts.
- Lien W.C.
- Hsu S.H.
- Chong K.M.
- et al.
US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: validation and potential impact.
Resuscitation. 2018; 127: 125-131
A prospective study was conducted from November 2019 to June 2020, and 15 emergency and 8 internal medicine residents of the National Taiwan University Hospital, who had passed the ALS provider course, attended the half-day course including pre-test, didactics, small-group hand-on training (instructor: trainees, 1:3), and post-course assessment. The study was approved by the Institutional Review Boards of the hospital (201812023RINA) and registered at Clinicaltrial.gov (NCT04148794). Inform consent was obtained before the start of the training.
In addition to a written test (10 questionnaires) before and after the course, skill performance (megacode) was evaluated using the 5-point Likert scale at the end of the course using the BodyWorks simulator (a high-fidelity US simulator including vital signs and electrocardiography). The participants were recalled 3 months later and received the written and skill test.
After training, there was a significant improvement in knowledge (the number of the correct questionnaires, 8.6 ± 0.9 pre-test vs. 9.3 ± 0.7 post-test, p = 0.0004). However, it decayed after 3 months (9.3 ± 0.7 vs. 8.8 ± 1.0, p = 0.036). The participants self-reported they used these protocols clinically with an average number of 9 ± 5 sonographic examinations before recalling. Although no significant difference existed between the immediate and recalling skill assessment (4.2 ± 0.5, vs. 4.0 ± 0.7, p = 0.203), the emergency medicine residents performed more sonographic examinations and the skill performance was better in the recalling, comparing with that of internal medicine residents (Supplementary file 2). The results implied that the knowledge and skill would be reviewed at least in a 3-month interval. Also, the more sonographic examinations performed, the better the skill retention in the recalling.
This pioneering study provides a concept of the possible next generation of ALS. Also, it demonstrates the feasibility of eALS curriculum. Although the number of trainees was limited, the results showed the knowledge and skill would need retraining with a 3-month interval. Further validation of its efficacy and impact on clinical performance is mandated.
Thanks to the financial support of the Ministry of Science and Technology, Taiwan (108-2511-H-002 -001).
Appendix A. Supplementary data
The following are Supplementary data to this article:
- Adult advanced life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Resuscitation. 2020; 156: A80-A119
- Advanced life support training.Resuscitation. 2001; 50: 9-11
- The RUSH exam: rapid ultrasound in SHock in the evaluation of the critically ill.Emerg Med Clin North Am. 2010; 28: 29-56
- BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.Chest. 2015; 147: 1659-1670
- US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: validation and potential impact.Resuscitation. 2018; 127: 125-131
Published online: February 02, 2021
Received: January 20, 2021
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