Volume 12 Issue 2

Identifying cardiac activity using focused ultrasound in non-shockable arrests

Background: Each year, around 60 000 people in the UK experience an out-of-hospital cardiac arrest. The introduction of additional diagnostic tools such as focused cardiac ultrasound (FoCUS) aids assessment and management of patients at the point of care. The Resuscitation Council guidance recommends its use where possible. Method: A systematic literature search was undertaken of two databases, PubMed and Science Direct primarily to identify literature relevant to the use of ultrasound in medical cardiac arrests where the prevailing cardiac rhythm was non-shockable. Results: A total of 10 papers were included in the review out of 242 identified from the search. Across all papers, three themes were identified: prognostication, identification of reversible causes and true pulseless electrical activity (PEA) versus pseudo PEA. Conclusion: The evidence shows there is an association between cardiac activity identified with FoCUS and an increase in return of spontaneous circulation (ROSC) rates. The effect of FoCUS for improving survival is not statistically significant; however, there is a higher likelihood of survival because of its ability to aid decision making. Patients with cardiac motion identified by FoCUS had higher ROSC rates than those without. Although the data suggest that the presence of cardiac activity is highly associated with ROSC, there is little literature surrounding long-term outcomes of patients, so the ability of FoCUS to determine survival cannot be confirmed.

Sequels of the COVID-19 pandemic on prehospital care professionals

As the COVID-19 pandemic and associated measures continue to have an impact on global populations, Guillaume Alinier explores the effects on the wellbeing of frontline prehospital care professionals and what can be done to support them to continue providing high-calibre care and growing as a profession

Differential rater function over time (DRIFT) during student simulations

Background: The field of paramedicine continues to advance in scope. Simulation training is frequently used to teach and evaluate students. Simulation examinations are often evaluated using a standardised global rating scale (GRS) that is reliable and valid. However, differential rater function over time (DRIFT) has not been evaluated when using the GRS during simulations. Aims: This study aimed to assess if DRIFT arises when applying the GRS. Methods: Data were collected at six simulation evaluations. Raters were randomly assigned to evaluate several students at the same station. Each station lasted 12 minutes and there was a total of 11 stations. A model to test DRIFT scores was created and was tested against both a leniency and perceptual model. Findings: Of the models explored, one that included students, the rater, and the dimensions had the greatest evidence (−3151 Bayes factors). This model was then tested against leniency (K=−9.1 dHart) and perceptual models (K=−7.1 dHart). This suggests a substantial finding against DRIFT; however, the tested models used a wide parameter so the possibility of a minor effect is not fully excluded. Conclusion: DRIFT was not found; however, further studies with multiple centres and longer evaluations should be conducted.