Point-of-care testing in out-of-hospital cardiac arrest: a retrospective analysis of relevance and consequences.
Blood gas analysis
Hyperkalaemia
Hypokalaemia
H’s and T’s
OHCA
Out-of-hospital cardiac arrest
POCT
Point-of-care-testing
Resuscitation
Journal
Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
Titre abrégé: Scand J Trauma Resusc Emerg Med
Pays: England
ID NLM: 101477511
Informations de publication
Date de publication:
30 Aug 2021
30 Aug 2021
Historique:
received:
03
05
2021
accepted:
23
08
2021
entrez:
31
8
2021
pubmed:
1
9
2021
medline:
7
9
2021
Statut:
epublish
Résumé
Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT). We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient's eventual outcome. N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE < - 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16). Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid-base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.
Sections du résumé
BACKGROUND
BACKGROUND
Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT).
METHODS
METHODS
We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient's eventual outcome.
RESULTS
RESULTS
N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE < - 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16).
CONCLUSIONS
CONCLUSIONS
Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid-base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.
Identifiants
pubmed: 34461967
doi: 10.1186/s13049-021-00943-w
pii: 10.1186/s13049-021-00943-w
pmc: PMC8406837
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
128Informations de copyright
© 2021. The Author(s).
Références
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):63-81
pubmed: 20123673
Respirology. 2014 Feb;19(2):168-175
pubmed: 24383789
Resuscitation. 2010 Nov;81(11):1479-87
pubmed: 20828914
Resuscitation. 1997 Jan;33(3):233-43
pubmed: 9044496
Am J Emerg Med. 2006 Mar;24(2):156-61
pubmed: 16490643
Resuscitation. 2016 Aug;105:188-95
pubmed: 27321577
Heart. 1998 Oct;80(4):412-4
pubmed: 9875126
Acta Anaesthesiol Scand. 2005 Jan;49(1):6-15
pubmed: 15675975
Adv Physiol Educ. 2016 Dec;40(4):480-490
pubmed: 27756725
Am J Emerg Med. 1985 Mar;3(2):132-6
pubmed: 3918547
Resuscitation. 1995 Apr;29(2):89-95
pubmed: 7659873
Prehosp Emerg Care. 2009 Oct-Dec;13(4):469-77
pubmed: 19731159
Am J Emerg Med. 2016 Feb;34(2):225-9
pubmed: 26597330
Crit Care Med. 1985 Nov;13(11):888-92
pubmed: 3931977
Am J Emerg Med. 2013 Mar;31(3):562-5
pubmed: 23246112
BMC Emerg Med. 2019 May 2;19(1):30
pubmed: 31046680
Resuscitation. 2015 Oct;95:100-47
pubmed: 26477701
Am J Emerg Med. 1992 Jan;10(1):4-7
pubmed: 1736913
Am J Emerg Med. 2018 Nov;36(11):1998-2004
pubmed: 29534919
Resuscitation. 2015 Oct;95:148-201
pubmed: 26477412