Point-of-care blood analysis of hypotensive patients in the emergency department

Shin, Hyungoo; Lee, Inhye; Kim, Changsun

doi:10.1016/j.ajem.2019.158363

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…The search strategy identified a total of 11,834 records, of which 6914 were non‐duplicates. After applying all inclusion and exclusion criteria, 118 studies were included in the scoping review, as shown in Figure 1 11–128 …”

Section: Resultsmentioning

confidence: 99%

Intra‐arrest blood‐based biomarkers for out‐of‐hospital cardiac arrest: A scoping review

Benoit,

Hogan,

Connelly

et al. 2024

JACEP Open

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ObjectiveBlood‐based biomarkers play a central role in the diagnosis and treatment of critically ill patients, yet none are routinely measured during the intra‐arrest phase of out‐of‐hospital cardiac arrest (OHCA). Our objective was to describe methodological aspects, sources of evidence, and gaps in research surrounding intra‐arrest blood‐based biomarkers for OHCA.MethodsWe used scoping review methodology to summarize existing literature. The protocol was designed a priori following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Extension for Scoping Reviews. Inclusion criteria were peer‐reviewed scientific studies on OHCA patients with at least one blood draw intra‐arrest. We excluded in‐hospital cardiac arrest and animal studies. There were no language, date, or study design exclusions. We conducted an electronic literature search using PubMed and Embase and hand‐searched secondary literature. Data charting/synthesis were performed in duplicate using standardized data extraction templates.ResultsThe search strategy identified 11,834 records, with 118 studies evaluating 105 blood‐based biomarkers included. Only eight studies (7%) had complete reporting. The median number of studies per biomarker was 2 (interquartile range 1–4). Most studies were conducted in Asia (63 studies, 53%). Only 22 studies (19%) had blood samples collected in the prehospital setting, and only six studies (5%) had samples collected by paramedics. Pediatric patients were included in only three studies (3%). Out of eight predefined biomarker categories of use, only two were routinely assessed: prognostic (97/105, 92%) and diagnostic (61/105, 58%).ConclusionsDespite a large body of literature on intra‐arrest blood‐based biomarkers for OHCA, gaps in methodology and knowledge are widespread.

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Section: Resultsmentioning

confidence: 99%

Intra‐arrest blood‐based biomarkers for out‐of‐hospital cardiac arrest: A scoping review

Benoit,

Hogan,

Connelly

et al. 2024

JACEP Open

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“…In two studies, results of capillary blood analyzed with EPOC were compared to corresponding results of venous or arterial samples performed with standard devices in critically ill patients (Kim and Kim, 2018;Shin et al, 2020). The studies suggested that portable BGA are useful for application in intensive care or emergency services when rapid sampling and on-site analysis of blood is essential.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Portable Blood Gas Analyzer for Use in Challenging Field Conditions at High Altitude

et al. 2021

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BackgroundNovel, portable blood gas analyzers (BGAs) may serve as essential point-of-care tools in remote regions, during air travel or in ambulance services but they have not been extensively validated.Research QuestionWe compared accuracy of a portable BGA to a validated stationary device.MethodsIn healthy individuals and patients with chronic obstructive pulmonary disease participating in clinical field studies at different altitudes, arterial blood samples were obtained at rest and during exercise in a hospital at 760 m and in a high altitude clinic at 3100 m. Paired measurements by a portable BGA (EPOC, Siemens Healthcare) and a stationary BGA (Rapidpoint500, Siemens Healthcare) were performed to compute bias (mean difference) and limits of agreement (95% CI of bias).ResultsOf 105 individuals, 248 arterial blood samples were analyzed, 108 at 760 m, 140 at 3100 m. Ranges of values measured by portable BGA were: pH 7.241−7.473, PaCO2 21.5−52.5 mmHg, and PaO2 45.5−107.1 mmHg. Bias (95% CI) between devices were: pH 0.007 (−0.029 to 0.044), PaCO2 −0.3 mmHg (−4.8 to 4.2), and PaO2 −0.2 mmHg (−9.1 to 4.7). For pH, agreement between devices was improved by the equation to correct pH by portable BGA = −1.37 + pHmeasured × 1.19; bias after correction −0.007 (−0.023 to 0.009). The portable BGA was easily handled and worked reliably.InterpretationAccuracy of blood gas analysis by the portable BGA in comparison to the reference BGA was adequate for clinical use. Because of portability and ease of handling, portable BGA are valuable diagnostic tools for use in everyday practice as well as under challenging field conditions.

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Correlation and agreement between arterial and venous blood gas analysis in patients with hypotension—an emergency department-based cross-sectional study

et al. 2023

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Background Blood gas analysis is integral to assessing emergency department (ED) patients with acute respiratory or metabolic disease. Arterial blood gas (ABG) is the gold standard for oxygenation, ventilation, and acid–base status but is painful to obtain. Peripheral venous blood gas (VBG) is a valuable alternative as it is less painful and easy to collect. The comparability of ABG and VBG was studied in various conditions. But in hypotension, previous findings were inconsistent. So, we studied the correlation and agreement between ABG and VBG in hypotensive patients. Methodology The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with hypotension above 18 years who satisfied the inclusion criteria were clinically evaluated. Patients who require ABG as a part of routine care were sampled. ABG was collected from the radial artery. VBG was obtained from the cubital or dorsal hand veins. Both samples were collected within 10 min and were analyzed. All ABG and VBG variables were entered in premade proforma. The patient was then treated and disposed of according to institutional protocol. Results A total of 250 patients were enrolled. The mean age was 53.25 ± 15.71 years. 56.8% were male. The study included 45.6% septic, 34.4% hypovolemic, 18% cardiogenic, and 2% obstructive shock patients. The study found a strong correlation and agreement for ABG and VBG pH, pCO2, HCO3, lactate, sodium, potassium, chloride, ionized calcium, blood urea nitrogen, base excess, and arterial/alveolar oxygen ratio. Hence, regression equations were made for the aforementioned. There was no correlation observed between ABG and VBG pO2 and SpO2. Our study concluded that VBG could be a reasonable alternative for ABG in hypotensive patients. We can also mathematically predict values of ABG from VBG using regression equations derived. Conclusions ABG sampling causes most unpleasant experiences to patients and is associated with complications like arterial injury, thrombosis, air or clotted-blood embolism, arterial occlusion, hematoma, aneurysm formation, and reflex sympathetic dystrophy. The study has shown strong correlations and agreements for most ABG and VBG parameters and can predict ABG mathematically using regression formulas formulated from VBG. This will decrease needle stick injury, consume less time, and make blood gas evaluation easy in hypotensive settings.

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Point-of-care blood analysis of hypotensive patients in the emergency department

Cited by 4 publications

References 30 publications

Intra‐arrest blood‐based biomarkers for out‐of‐hospital cardiac arrest: A scoping review

Intra‐arrest blood‐based biomarkers for out‐of‐hospital cardiac arrest: A scoping review

Validation of a Portable Blood Gas Analyzer for Use in Challenging Field Conditions at High Altitude

Correlation and agreement between arterial and venous blood gas analysis in patients with hypotension—an emergency department-based cross-sectional study

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