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

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Abstract

Purpose

To compare, quantify, and describe the time-delays associated with four common methods of adrenaline administration in the simulated setting of impending cardiac arrest.

Methods

Using 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.

Results

Median 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.

Conclusions

We 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.

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