Goldilocks in cardiac arrest: A scoping review of invasive hemodynamic monitoring in the pre-hospital setting for getting adrenaline dosing just right
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Keywords

Out of hospital cardiac arrest (OHCA)
Invasive blood pressure (IBP)
Arterial line
Guided adrenaline dosing
Paramedicine

How to Cite

1.
Wijland Y. Goldilocks in cardiac arrest: A scoping review of invasive hemodynamic monitoring in the pre-hospital setting for getting adrenaline dosing just right . Australasian Journal of Paramedicine [Internet]. 2021May30 [cited 2021Jun.23];18. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/890

Abstract

Introduction

A one-size-fits-all approach to adrenaline dosing is likely to be sub-optimal for out-of-hospital cardiac arrest given the diverse nature of patient age, bodyweight, frailty and intra-arrest coronary perfusion pressure. An individualised adrenaline dosing approach to cardiac arrest using invasive blood pressure monitoring has been shown to increase rates of return of spontaneous circulation in the hospital setting, but evidence for this approach has not yet been reviewed in the pre-hospital setting.

Methods

A scoping review was undertaken using Science Direct, ProQuest, PubMed, CINAHL Complete and GALE Health and Wellness databases with the search terms ‘arterial line’, ‘pre-hospital’, ‘cardiac arrest’ and similar derivatives. Subject matter experts and authors of articles meeting inclusion criteria were also consulted to help identify further relevant studies. Articles were included if they pertained to the use of arterial lines in cardiac arrest in the pre-hospital field, and excluded if they related to traumatic cardiac arrest, in a language other than English, Dutch or French, or not retrievable as a full text.

Results

A total of 1408 articles were identified using the search method, of which three remained after de-duplication, use of inclusion and exclusion criteria, and full text appraisal. The current pre-hospital literature is lacking and avenues for further research to improve the evidence for hemodynamic guided resuscitation were identified.

Conclusion

Paramedic-initiated invasive arterial monitoring presents a new, but as yet unproven, intervention for improving cardiac arrest outcomes.

https://doi.org/10.33151/ajp.18.890
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References

Moon S, Ryoo H, Ahn J, et al. Association of response time interval with neurological outcomes after out-of-hospital cardiac arrest according to bystander CPR. Am J Emerg Med 2020;38:1760-6.

Song J, Guo W, Lu X, et al. The effect of bystander cardiopulmonary resuscitation on the survival of out-of-hospital cardiac arrests: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2018;26:86-96.

Capucci A, Aschieri D, Piepoli M, et al. Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation. Circulation 2002;106:1065-70.

McLeod S, Brignardello-Peterson R, Worster A, et al. Comparative effectiveness of antiarrhythmics for out-of-hospital cardiac arrest: a systematic review and network meta-analysis. Resuscitation 2017;121:90-7.

Perkins G, Ji C, Deakin C, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med 2018;379:711-21.

Correll CU. From receptor pharmacology to improved outcomes: individualising the selection, dosing, and switching of antipsychotics. Eur Psychiatry 2010;25:S12-21.

Rothwell P, Cook N, Gaziano J, et al. Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials. Lancet 2018;392:387-99.

Chen C. The remarkable therapeutic potential of response-based dose individualisation in drug trials and patient care. Drug Discov Today 2018;23:1463-8.

Paradis N, Martin G, Rivers E, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. J Am Med Assoc 1990;263:1106-13.

Miraglia D, Miguel L, Alonso W. Esmolol in the management of pre-hospital refractory ventricular fibrillation: a systematic review and meta-analysis. Am J Emerg Med 2020;38:1921-34.

Cao L, Weil M, Sun S, Tang W. Vasopressor agents for cardiopulmonary resuscitation. J Cardiovasc Pharmacol Ther 2003;8:115-21.

Ristagno G, Sun S, Tang W, Castillo C, Weil M. Effects of epinephrine and vasopressin on cerebral microcirculatory flows during and after cardiopulmonary resuscitation. Crit Care Med 2007;35:2145-9.

Ornato JP. Hemodynamic monitoring during CPR. Ann Emerg Med 1993;22(2, Part 2):289-95.

Sanders AB, Ogle M, Ewy GA. Coronary perfusion pressure during cardiopulmonary resuscitation. Am J Emerg Med 1985;3:11-4.

Sutton R, Friess S, Maltese M, et al. Hemodynamic-directed cardiopulmonary resuscitation during in-hospital cardiac arrest. Resuscitation 2014;85:983-6.

Meaney P, Bobrow B, Mancini M, et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation 2013;128:417-35.

Flower O. Cutting edge cardiac arrest Life In The Fast Lane: Life In The Fast Lane (LITFL); 2020. Available at: https://litfl.com/cutting-edge-cardiac-arrest/

Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care 2002;6:199-204.

Wildner G, Pauker N, Archan S, et al. Arterial line in prehospital emergency settings – a feasibility study in four physician-staffed emergency medical systems. Resuscitation 2011;82:1198-201.

Marquez A, Morgan R, Ross C, Berg R, Sutton R. Physiology-directed cardiopulmonary resuscitation: advances in precision monitoring during cardiac arrest. Curr Opin Crit Care 2018;24:143-50.

Shiver S, Blaivas M, Lyon M. A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters. Acad Emerg Med 2006;13:1275-9.

Critical Appraisal Skills Programme. CASP qualitative checklist 2018. Available at: https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf

Wildner G, Prause G, Archan S, Kaltenböck F. Tight control of effectiveness of cardiac massage with invasive blood pressure monitoring during cardiopulmonary resuscitation. Am J Emerg Med 2010;28:e5-6.

Manning J. Feasibility of blind aortic catheter placement in the prehospital environment to guide resuscitation in cardiac arrest. J Trauma Acute Care Surg 2013;75:S173-7.

Karlsson J, Linde J, Svensen C, Gellerfors M. Prehospital invasive arterial pressure: use of a minimised flush system. Prehosp Disaster Med 2018;33:490-4.

Sigal A, Sandel K, Buckler D, Wasser T, Abella B. Impact of adrenaline dose and timing on out-of-hospital cardiac arrest survival and neurological outcomes. Resuscitation 2019;139:182-8.

Bogseth M. Predictors of neurologic outcome in patients resuscitated from out-of-hospital cardiac arrest using classification and regression tree analysis. J Emerg Med 2015;48:262.

Woodhouse S, Cox S, Boyd P, Case C, Weber M. High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest. Resuscitation 1995;30:243-9.

Brown D. A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. J Emerg Med 1993;11:498.

Hansen M, Schmicker R, Newgard C, et al. Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults. Circulation 2018;137:2032-40.

Ran L, Liu J, Tanaka H, et al. Early administration of adrenaline for out-of-hospital cardiac arrest: a systematic review and meta-analysis. J Am Heart Assoc 2020;9:1-13.

Rieke H, Rieke M, Gado S, et al. Virtual arterial blood pressure feedback improves chest compression quality during simulated resuscitation. Resuscitation 2013;84:1585-90.

Johnson M. The structured clinical approach. In: Johnson M, Boyd L, Grantham H, Eastwood K, editors. Paramedic principles and practice ANZ: a clinical reasoning approach. Chatswood, Australia: Elsevier; 2017. p. 32-42.

Crowley C, Salciccioli J, Kim E. The association between ACLS guideline deviations and outcomes from in-hospital cardiac arrest. Resuscitation 2020;153:65-70.

Johnson B, Runyon M, Weekes A, Pearson D. Team-focused cardiopulmonary resuscitation: prehospital principles adapted for emergency department cardiac arrest resuscitation. J Emerg Med 2018;54:54-63.

Brindley P, Reynolds S. Improving verbal communication in critical care medicine. J Crit Care 2011;26:155-9.

Fok P, Teubner D, Purdell-Lewis J, Pearce A. Predictors of prehospital on-scene time in an Australian emergency retrieval service. Prehosp Disaster Med 2018;34:317-21.

Yamamoto R, Cestero R, Suzuki M, Funabiki T, Sasaki J. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is associated with improved survival in severely injured patients: a propensity score matching analysis. Am J Surg 2019;218:1162-8.

Valkenburg A, Bennett D, Bishop J, Smith G. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as a potential pre-hospital procedure for the control of non-compressible haemorrhage: a literature review. Australasian Journal of Paramedicine 2015;12:1-8.

Gronheck C, Miller E. Nonphysician Placement of arterial catheters: experience with 500 insertions. Chest 1993;104:1716-7.

White L, Halpin A, Turner M, Wallace L. Ultrasound-guided radial artery cannulation in adult and paediatric populations: a systematic review and meta-analysis. Br J Anaesth 2016;116:610-7.

Guy A, Bryson A, Wheeler S, McLean N, Kanji HD. A blended prehospital ultrasound curriculum for critical care paramedics. Air Med J 2019;38:426-30.

Sun J, Huang C, Huang Y, et al. Prehospital ultrasound. J Med Ultrasound 2014;22:71-7.