Echo can be incorporated into current resuscitation practice

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Novice echocardiographers can obtain the knowledge and skills relevant to advanced life support (ALS)-compliant peri-resuscitation echocardiography using a range of educational techniques, according to a study in the November issue of Resuscitation.

In addition to the standard one-day training courses available, continued mentored practice and didactic adherence to ALS algorithms is required.

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, according to the researchers.

"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," they wrote.

Susanna Price, MD, from the Royal Brompton and Harefield NHS Foundation Trust in London, and colleagues evaluated the effectiveness of a number of different educational methods used teach echocardiography to 204 participants attending standardized structured one-day training courses in peri-resuscitation echocardiography. They were comprised of emergency physicians, intensivists and anesthetists.

Researchers assessed the subjects 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.

They found a significant improvement in knowledge and interpretation of echocardiographic images after completion of the one-day course: from 62 percent to 78 percent.

Skills acquisition resulted in 100 percent of participants being able to obtain a subcostal view of diagnostic quality by the end of the course, and 86 percent with a mean time to acquisition of less than 10 seconds.

They also found that incorporation of echocardiography into their current resuscitation practice did not compromise ALS-compliance.

"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 authors wrote.

Teaching methods employed included a combination of lectures, small group teaching and skills training. All lectures were short 20-minute illustrated lectures designed and delivered assuming no prior echocardiography knowledge, with time for discussion in each lecture.

Where small group teaching was undertaken, the trainer-to-participant ratio was 1:3. Practical skills training included rotating through 12 hands-on training (HOT) stations teaching each of the four standard echocardiography views (three stations per view).

Additional HOT skills stations were designed to teach implementing echocardiography skills within a strict timeframe (one station) and to provide the opportunity for individualized echocardiography mentorship (one station). The remaining HOT stations were devoted to teaching integration of the newly acquired skills into the ALS-algorithm using a real-time transthoracic echocardiography simulator incorporated into a standardized ALS resuscitation training mannequin. An additional station incorporated a computerized test of image identification and interpretation.

The researchers found that study participants were able to interpret images with an accuracy of 84 percent, comparable with those shown by other investigators, despite the participants being time-limited for image interpretation.

After lecture-based training alone, compliance with the eight stages assessed in application of echocardiography in a simulated resuscitation scenario was suboptimal. This improved in all stages following small group study, including feedback and debriefing.

"This study shows that on completion of one day of echocardiography training, participants can acquire knowledge, skills and behaviors relevant to the peri-resuscitation scenario, however, this does not imply competence," they concluded.