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Corresponding author at: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, No.7, Chung-Shan South Road, Taipei 100, Taipei, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, TaiwanDepartment of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, TaiwanDepartment of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, TaiwanDepartment of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Adult advanced life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
The 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.
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.
Besides 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.
Fig. 1The cardiac assessment plus the BLUE protocol was adopted for patients with chest pain/dyspnea. PSLA, parasternal long axis; PSSA, parasternal short axis; A4C, apical four-chamber; Ao, aorta; LV, left ventricle; RWMA, regional wall motion abnormality; ACS, acute coronary syndrome; DVT, deep vein thrombosis; DAA, dissecting aortic aneurysm.
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.
Acknowledgement
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.
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