Introduction of an Extracorporeal Cardiopulmonary Resuscitation Eligibility Protocol for Paramedics in Atlantic Canada: A Pilot Knowledge Translation Project

Colin P Rouse; Jay Mekwan; Paul Atkinson; Derek Rollo; Jacqueline Fraser; Joanna Middleton; Tushar Pishe; Michael Howlett; Sohrab Lutchmedial; Jean-François Légaré; Steve Chanyi; Mark Tutschka; Ansar Hassan; James Gould

doi:10.7759/cureus.6185

Introduction of an Extracorporeal Cardiopulmonary Resuscitation Eligibility Protocol for Paramedics in Atlantic Canada: A Pilot Knowledge Translation Project

Cureus. 2019 Nov 18;11(11):e6185. doi: 10.7759/cureus.6185.

Authors

Affiliations

¹ Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, CAN.
² Emergency Medicine, Horizon Health Network, Saint John, CAN.
³ Emergency Medicine, Saint John Regional Hospital, Saint John, CAN.
⁴ Family Medicine, Saint John Regional Hospital, Saint John, CAN.
⁵ Emergency Medicine, Saint John Regional Hospital / Horizon Health Network, Saint John, CAN.
⁶ Interventional Cardiology, Saint John Regional Hospital / Dalhousie University, Saint John, CAN.
⁷ Cardiac Surgery, Saint John Regional Hospital / Dalhousie University, Saint John, CAN.
⁸ Cardiac/Thoracic/Vascular Surgery, Saint John Regional Hospital, Saint John, CAN.
⁹ Critical Care Medicine, Saint John Regional Hospital / Dalhousie University, Saint John, CAN.
¹⁰ Emergency Medicine, Queen Elizabeth II Health Science Center / Dalhousie University, Halifax, CAN.

Abstract

Introduction There is currently no protocol for the initiation of extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest (OHCA) in Atlantic Canada. Advanced care paramedics (ACPs) perform advanced cardiac life support in the prehospital setting often completing the entire resuscitation on-scene. Implementation of ECPR will present a novel intervention that is only available at the receiving hospital. Our objective is to determine if an educational program can improve identification of ECPR candidates by paramedics. Establishing paramedic competence will ensure rapid transfer of eligible patients for a potentially life-saving intervention. Methods An educational program was delivered to paramedics including a short seminar and pocket card coupled with simulated OHCA cases. A before-and-after study design using a case-based survey was employed. Paramedics were scored on their ability to correctly identify patients suffering OHCA who met the inclusion criteria for our ECPR protocol. A Wilcoxon matched-pairs signed rank test was employed to compare paramedics' scores before and after the education delivery. A six-month follow-up is planned to assess retention. Qualitative data was also collected from paramedics during simulation to help identify practical issues, potential barriers, and to refine inclusion and exclusion criteria prior to the implementation of our protocol in the prehospital setting. Results The median score pre-education was 10 (IQR: 9-10.5) compared to 14 (IQR: 13-15) after education delivery. The median difference between groups was 5. The Wilcoxon matched-pairs test demonstrated a significant improvement in the paramedics' ability to correctly identify ECPR candidates after completing our educational program z = -2.67, p = 0.0039. Conclusion Paramedic training through a didactic session coupled with a pocket card and simulation appeared to be a feasible method of knowledge translation. Six-month follow-up data will help ensure knowledge retention is achieved.

Keywords: cardiac arrest; ecmo; ecpr; paramedic; prehospital; simulation.

Grants and funding

A 75 000 dollar grant was awarded from the Saint John Regional Hospital Foundation to the Department of Emergency Medicine Research Team to help fund the research and equipment required to implement ECPR.