Trends in use of intraosseous and intravenous access in out-of-hospital cardiac arrest across English ambulance services: A registry-based, cohort study.

INTRODUCTION: The optimum route for drug administration in cardiac arrest is unclear. Recent data suggest that use of the intraosseous route may be increasing. This study aimed to explore changes over time in use of the intraosseous and intravenous drug routes in out-of-hospital cardiac arrest in England. METHODS: We extracted data from the UK Out-of-Hospital Cardiac Arrest Outcomes registry. We included adult out-of-hospital cardiac arrest patients between 2015-2020 who were treated by an English Emergency Medical Service that submitted vascular access route data to the registry. The primary outcome was any use of the intraosseous route during cardiac arrest. We used logistic regression models to describe the association between time (calendar month) and intraosseous use. RESULTS: We identified 75,343 adults in cardiac arrest treated by seven Emergency Medical Service systems between January 2015 and December 2020. The median age was 72 years, 64% were male and 23% presented in a shockable rhythm. Over the study period, the percentage of patients receiving intraosseous access increased from 22.8% in 2015 to 42.5% in 2020. For each study-month, the odds of receiving any intraosseous access increased by 1.019 (95% confidence interval 1.019 to 1.020, p < 0.001). This observed effect was consistent across sensitivity analyses. We observed a corresponding decrease in use of intravenous access. CONCLUSION: In England, the use of intraosseous access in out-of-hospital cardiac arrest has progressively increased over time. There is an urgent need for randomised controlled trials to evaluate the clinical effectiveness of the different vascular access routes in cardiac arrest.

Peer observation of teaching as a faculty development tool.

BACKGROUND: Peer observation of Teaching involves observers providing descriptive feedback to their peers on learning and teaching practice as a means to improve quality of teaching. This study employed and assessed peer observation as a constructive, developmental process for members of a Pediatric Teaching Faculty. METHODS: This study describes how peer observation was implemented as part of a teaching faculty development program and how it was perceived by teachers. The PoT process was divided into 4 stages: pre-observation meeting, observation, post-observation feedback and reflection. Particular care was taken to ensure that teachers understood that the observation and feedback was a developmental and not an evaluative process. Twenty teachers had their teaching peer observed by trained Faculty members and gave an e-mail 'sound-bite' of their perceptions of the process. Teaching activities included lectures, problem-based learning, small group teaching, case-based teaching and ward-based teaching sessions. RESULTS: Teachers were given detailed verbal and written feedback based on the observer's and students' observations. Teachers' perceptions were that PoT was useful and relevant to their teaching practice. Teachers valued receiving feedback and viewed PoT as an opportunity for insight and reflection. The process of PoT was viewed as non-threatening and teachers thought that PoT enhanced the quality of their teaching, promoted professional development and was critical for Faculty development. CONCLUSIONS: This study demonstrated that PoT can be used in a constructive way to improve course content and delivery, to support and encourage medical teachers, and to reinforce good teaching.