In this episode, I’ll discuss prehospital administration of epinephrine and norepinephrine infusions.
While vasopressor infusions are a mainstay of supportive care of critically ill patients, these therapies are usually started once the patient arrives at the hospital. With the increased amount of data supporting the peripheral administration of vasopressors, it is logical that clinicians in the prehospital setting would want to use these medications to stabilize the cardiovascular system of patients being transported to the hospital.
A group of authors published in Academic Emergency Medicine a prospective, observational cohort study including patients transferred by Lifeflight Medicine looking at the safety of peripheral vasoactive medication administration.
Date from just under 500 patients were analyzed. The vast majority of the patients studied – almost three-quarters – were transferred to the hospital via helicopter. The median dose of norepineprhine was 0.1 mcg/kg/min and it was 0.13 mcg/kg/min for epinephrine. About half of the patients had septic shock. The median duration of infusion was 85 min.
The safety results were impressive – over 93% of patients had no safety related events. 2.8% had minor technical issues with vasopressor delivery, 3% had minor complications, and 0.8% of patients needed to transition to central venous access.
At 24 hours follow-up, there were zero tissue-damage complications from vasopressor administration.
The authors conclude:
Our data suggests that adrenaline and noradrenaline may be safely administered peripherally in Prehospital and Retrieval Medicine environments, with a low overall risk of complications.
While this study was based in Australia, the data on the safety of peripheral vasopressors combined with the additional information provided by this study means it is likely that US-based clinicians would want similar access to pre-hospital vasopressors. Hospital pharmacists can get involved with their local EMS group’s medical advisory committee and help with protocol development for prehospital vasopressors as well as hospital protocol development for how to switch an ED patient to the hospital’s own vasopressors once they arrive in the ED.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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