Time delays associated with vasoactive medication preparation and delivery in simulated patients at risk of cardiac arrest

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PurposeTo compare, quantify, and describe the time-delays associated with four common methods of adrenaline administration in the simulated setting of impending cardiac arrest.MethodsUsing sham medication and a high-fidelity simulator, experienced Nurses prepared, then delivered, adrenaline by: i) bolus, ii) lower-concentration infusion iii) higher-concentration infusion, and iv) higher-concentration infusion plus carrier-line. We recorded medication preparation and delivery time, plus administration errors and self-reported competence.ResultsMedian total delay was i) 120 s for bolus (95% CI 112–128 s); ii) 179 s for lower concentration infusion (95% CI 172–186 s); iii) 296 s for higher concentration infusion (95% CI 285–307 s); and iv) 411 s for higher concentration infusion plus carrier line (95% CI 399–423 s). Time to prepare/deliver a bolus was less than any infusion (p < 0.001). Time to prepare/deliver a lower-concentration infusion was less than either higher-concentration infusion (p < 0.001). No substantial equipment failures or medication errors were observed. Participants reported high-competence. The majority of delay was from drug preparation not delivery.ConclusionsWe highlight potentially dangerous delays with administration of life-saving medications by all four methods. We should prioritize boluses, and focus on improving drug preparation times and human performance, more than drug delivery and equipment.HighlightsWe compare and quantify potential delays with both the preparation and delivery of vasoactive medications by bolus, and three common infusionsThe delay was shortest with a bolus. The delay was longer with lower-concentration infusion, then higher-concentration infusion, then carrier line.We highlight the need to prioritize boluses, and why we should be wary of overreliance upon de novo infusions.Our study suggests greater time savings by addressing drug preparation and human factors, rather than drug delivery and equipment.This work highlights the need to prepare bolus infusions and teams ahead of time.

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