Randomized Controlled Trial of Point-of-Care Ultrasound Education for the Recognition of Tension Pneumothorax by Paramedics in Prehospital Simulation

Abstract

Objective: The primary goal of this study was to determine if ultrasound (US) use after brief point-of-care ultrasound (POCUS) training on cardiac and lung exams would result in more paramedics correctly identifying a tension pneumothorax (TPTX) during a simulation scenario. Methods: A randomized controlled, simulation-based trial of POCUS lung exam education investigating the ability of paramedics to correctly diagnose TPTX was performed. The US intervention group received a 30-minute cardiac and lung POCUS lecture followed by hands-on US training. The control group did not receive any POCUS training. Both groups participated in two scenarios: right unilateral TPTX and undifferentiated shock (no TPTX). In both scenarios, the patient continued to be hypoxemic after verified intubation with pulse oximetry of 86%-88% and hypotensive with a blood pressure of 70/50. Sirens were played at 65 decibels to mimic prehospital transport conditions. A simulation educator stated aloud the time diagnoses were made and procedures performed, which were recorded by the study investigator. Paramedics completed a pre-survey and post-survey. Results: Thirty paramedics were randomized to the control group; 30 paramedics were randomized to the US intervention group. Most paramedics had not received prior US training, had not previously performed a POCUS exam, and were uncomfortable with POCUS. Point-of-care US use was significantly higher in the US intervention group for both simulation cases (P <.001). A higher percentage of paramedics in the US intervention group arrived at the correct diagnosis (77%) for the TPTX case as compared to the control group (57%), although this difference was not significantly different (P = 0.1). There was no difference in the correct diagnosis between the control and US intervention groups for the undifferentiated shock case. On the post-survey, more paramedics in the US intervention group were comfortable with POCUS for evaluation of the lung and comfortable decompressing TPTX using POCUS (P <.001). Paramedics reported POCUS was within their scope of practice. Conclusions: Despite being novice POCUS users, the paramedics were more likely to correctly diagnose TPTX during simulation after a brief POCUS educational intervention. However, this difference was not statistically significant. Paramedics were comfortable using POCUS and felt its use improved their TPTX diagnostic skills.

Helicopter emergency medical services use of thoracic point of care ultrasound for pneumothorax: a systematic review and meta-analysis

“…A further three were also rejected as they did not involve assessment for pneumothorax [ 30 , 32 , 34 ]. Of the remaining twelve studies included in qualitative synthesis [ 1 – 6 , 22 – 26 , 33 ], eight reported sufficient and appropriate data for inclusion in meta-analysis [ 1 – 6 , 22 , 24 ]. Figure 3 depicts this study selection process.…”

“…All twelve included studies were published between 2011 and 2020 [ 1 – 6 , 22 – 26 , 33 ]. Collectively, they reported on the interpretations of n = 1,936 images captured predominantly from trauma patients presenting in the pre-hospital and/or in-flight setting.…”

“…All included patients were adults (≥ 18 years). Apart from one randomised simulation trial [ 26 ], all were observational designs. Results involved overall quantitative and qualitative evaluations, including the raw data used to make these calculations and subjective conclusions.…”

“…Of the twelve studies yielded by the search strategy [ 1 – 6 , 22 – 26 , 33 ], four were excluded from meta-analysis [ 23 , 25 , 26 , 33 ]. The Snaith et al study was excluded as it did not report sufficient accuracy data [ 33 ].…”

Tension Pneumothorax in Prehospital Setting

“…We've read the article by Khalil, et al entitled "Randomized Controlled Trial of Point-of-Care Ultrasound Education for the Recognition of Tension Pneumothorax by Paramedics in Prehospital Simulation" with great interest. 1 The investigated disease is one which timesensitive intervention has an enormous effect on patient mortality. Thus, getting better at prehospital management of tension pneumothorax becomes paramount of importance.…”