Echocardiography does not prolong peri-shock pause in cardiopulmonary resuscitation using the COACH-RED protocol with non-expert sonographers in simulated cardiac arrest

OBJECTIVE: Focused echocardiography during peri-shock pause (PSP) can prognosticate and detect reversible causes in cardiac arrest but minimising interruptions to chest compressions improves outcome. The COACH-RED protocol was adapted from the COACHED protocol to systematically incorporate echocardiography into rhythm check without prolonging PSP beyond the recommended 10 s. The primary objective of this study was to test the feasibility of emergency nurses learning to perform all roles in the COACH-RED protocol. PSP duration and change in participant confidence were secondary outcomes. METHODS: After an initial two-hour workshop, five ALS-trained nurses were assessed for the correct use of COACH-RED protocol, without critical error, in three simulated cardiac arrest scenarios of four cycles each. Assessments were repeated on days 7 and 35. On day 35, three COACHED scenarios were also assessed for comparison. Participant roles per scenario and cardiac rhythm per cycle were randomised. Participants completed questionnaires on their confidence levels. Sessions were videotaped for accurate measurement of PSP duration and results tabulated for simple comparison. Statistical analysis was not performed due to small sample size. RESULTS: There were no critical errors, two minor team-leading errors and two minor echosonography errors. Minor errors occurred in separate scenarios resulting in a 100% pass rate overall by predetermined criteria. Echocardiographic recordings were 100% adequate. Overall median PSP was 9.35 s for COACH-RED and 6.94 s for COACHED. Sub-group analysis of COACH-RED revealed median PSP 10.80 s in shockable rhythms and 8.74 s (∼2 s less) in non-shockable rhythms. Mean participant confidence in performing COACH-RED improved from 1.6 to 4.6, on a 5-point scale. CONCLUSION: The COACH-RED protocol can be effectively performed by ALS-trained nurses, in all roles of this protocol, including echocardiography, in a simulated environment, after a single training session. Using this protocol, focused echocardiography does not prolong PSP beyond 10 s.