Dr Robbie Ley Greaves1, Dr Andrew Holgate1, Miss Renee Bolot1, Dr Aaron Quay1
1Lifeflight Retrieval Medicine, Brisbane, Australia
Abstract:
Introduction
Peripheral vasopressors use (PVU) is increasingly common in pre-hospital settings, although controversial given limited evidence of their safety in this setting. For the retreivalist this can cause significant hurdles to expediting care and facilitating smooth handover of care at both ends of a patient’s journey.
Methods
We conducted a 3 year retrospective review of all patients receiving peripheral vasopressors from August 2018 to August 2021 in Lifeflight retrieval medicine, Queensland. Paper and electronic records were reviewed for the indications for use, site, dose, duration of use and complications. Clinical governance records were searched for internal or external reports of complications. This led to an update of the standard operating procedure on PVU and creation of a specific electronic record for documenting PVU. A current prospective observational trial on PVU is ongoing in this service.
Results
The results of 419 retrospective and 400 prospective patients to date are presented. The most common indications were septic shock and shock of unknown cause. Average duration of PVU was 154 minutes. Average dose of noradrenaline and adrenaline rose from 10.4-11.6mcg/min and 12.5-16.6mcg/min respectively. There were no major complications across the 819 patients. Incidence of minor complications was 5% in the retrospective patients and 10% in the prospective cohort. Minor complications included line kinking, pressure alarms, tissued cannulas with no evidence of necrosis. These were associated with patient packaging, securing peripheral access and ultrasound guided access. This increase may reflect increased PVU or improved data capture.
Conclusion
This demonstrates PVU is safe in the largest cohort of out of hospital patients to date. Given the increasing frequency of their use, the risk of major complications remains very real. There are a number of simple measures that can be employed to ensure that the clinical benefit of PVU continues to outweigh the potential risk.
Biographies:
Senior registrar trained in the UK and Queensland. Robbie has an interest in prehospital and retrieval medicine especially around improving quality via research and clinical governance.