Prehospital Efficacy and Adverse Events Associated with Bolus Dose Epinephrine in Hypotensive Patients During Ground-Based EMS Transport

Background:The utility and efficacy of bolus dose vasopressors in hemodynamically unstable patients is well-established in the fields of general anesthesia and obstetrics. However, in the prehospital setting, minimal evidence for bolus dose vasopressor use exists and is primarily limited to critical...

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Bibliographic Details
Published in:Prehospital and disaster medicine 2020-10, Vol.35 (5), p.495-500
Main Authors: Patrick, Casey, Ward, Brad, Anderson, Jordan, Fioretti, Joe, Rogers Keene, Kelly, Oubre, Carri, Cash, Rebecca E., Panchal, Ashish R., Dickson, Robert
Format: Article
Language:English
Subjects:
Airway management
Anesthesia
Blood pressure
Critical care
Emergency medical care
Emergency medical services
Health services
Health technology assessment
Hypertension
Hypotension
Intubation
Mortality
Observational studies
Original Research
Paramedics
Patients
Sepsis
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Summary:Background:The utility and efficacy of bolus dose vasopressors in hemodynamically unstable patients is well-established in the fields of general anesthesia and obstetrics. However, in the prehospital setting, minimal evidence for bolus dose vasopressor use exists and is primarily limited to critical care transport use. Hypotensive episodes, whether traumatic, peri-intubation-related, or septic, increase patient mortality. The purpose of this study is to assess the efficacy and adverse events associated with prehospital bolus dose epinephrine use in non-cardiac arrest, hypotensive patients treated by a single, high-volume, ground-based Emergency Medical Services (EMS) agency.Methods:This is a retrospective, observational study of all non-cardiac arrest EMS patients treated for hypotension using bolus dose epinephrine from September 12, 2018 through September 12, 2019. Inclusion criteria for treatment with bolus dose epinephrine required a systolic blood pressure (SBP) measurement 180mmHg) occurred, but there were no episodes of unstable tachyarrhythmia or cardiac arrest while en route or upon arrival to the receiving hospitals.Conclusion:These preliminary data suggest that the administration of bolus dose epinephrine may be effective at rapidly augmenting hypotension in the prehospital setting with a minimal incidence of adverse events. Paramedic use of bolus dose epinephrine successfully increased SBP and MAP without clinically significant side effects. Prospective studies with larger sample sizes are needed to further investigate the effects of prehospital bolus dose epinephrine on patient morbidity and mortality.
ISSN:1049-023X
1945-1938
DOI:10.1017/S1049023X20000886