Abstract
Objectives
Ventilator management in prehospital settings using end-tidal CO2 can lead to inappropriate ventilation in the absence of point of care blood gas (POCBG) measurements. Implementation of POCBG testing in helicopter Emergency Medical Services (HEMS) is limited in part because of concern for preanalytical and analytical errors due to altitude, vibration, and other associated environmental factors and due to insufficient documentation of implementation challenges.
Methods
We performed accuracy and precision verification studies using standard materials tested pre-, in-, and post-flight (n=10) in a large HEMS agency. Quality assurance error log data were extracted and summarized for common POCBG errors during the first 31 months of use and air medical transport personnel were surveyed regarding POCBG use (n=63).
Results
No clinically significant differences were found between pre-, in-, and post-flight blood gas measurements. Error log data demonstrated a reduction in device errors over time. Survey participants found troubleshooting device errors and learning new clinical processes to be the largest barriers to implementation. Continued challenges for participants coincided with error log data including temperature and sampling difficulties. Survey participants indicated that POCBG testing improved patient management.
Conclusions
POCBG testing does not appear to be compromised by the HEMS environment. Temperature excursions can be reduced by use of insulated transport bags with heating and cooling packs. Availability of POCBG results in air medical transport appeared to improve ventilator management, increase recognition of ventilation-perfusion mismatch, and improve patient tolerance of ventilation.
Funding source: University of Pittsburgh
Award Identifier / Grant number: Unassigned
Funding source: National Institutes of Health
Award Identifier / Grant number: Unassigned
Acknowledgments
The authors would like to thank the following technologist who provided their point of care expertise to perform and implement this testing: Judy M. Wright MT(ASCP).
-
Research funding: The project described received technical support from the Clinical and Translational Sciences Institute at the University of Pittsburgh, which is supported by the National Institutes of Health through Grant Number UL1 TR001857, KL2 TR001856, and/or TL1 TR001858.
-
Author contribution: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Informed consent was obtained from all individuals included in this study.
-
Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013) and has been approved by the authors’ Institutional Review Board (Study 20090049).
References
1. Peck Palmer, OM, Wheeler, SE, Plebani, M, Patterson, PD, Korpi-Steiner, NL, Martin, C. Recognition of the prehospital preanalytical phase: collaborative efforts between laboratory medicine and emergency medicine to ensure quality testing. Clin Chem 2020;66:998–1005, https://doi.org/10.1093/clinchem/hvaa140.Search in Google Scholar PubMed
2. Wang, HE, Mann, NC, Mears, G, Jacobson, K, Yealy, DM. Out-of-hospital airway management in the United States. Resuscitation 2011;82:378–85, https://doi.org/10.1016/j.resuscitation.2010.12.014.Search in Google Scholar PubMed
3. Pham, T, Brochard, LJ, Slutsky, AS. Mechanical ventilation: state of the art. Mayo Clin Proc 2017;92:1382–400, https://doi.org/10.1016/j.mayocp.2017.05.004.Search in Google Scholar PubMed
4. Martin-Gill, C, Elmer, J, Guyette, F. Accuracy of ETCO2 as a surrogate for PCO2 in patients undergoing critical care transport. In: NAEMSP Scientific Assembly 2020:117 p.Search in Google Scholar
5. Schober, P, Bossers, SM, Koolwijk, J, Terra, M, Schwarte, LA. Prehospital coagulation measurement by a portable blood analyzer in a helicopter emergency medical service (HEMS). Am J Emerg Med 2021;46:137–40, https://doi.org/10.1016/j.ajem.2021.04.023.Search in Google Scholar PubMed
6. Füzéry, AK, Kost, GJ. Point-of-care testing by ambulance teams: an opportunity for a new standard|AACC.org [Internet]. Available from: https://www.aacc.org/cln/articles/2021/may/point-of-care-testing-by-ambulance-teams-an-opportunity-for-a-new-standard [Accessed 8 Dec 2021].Search in Google Scholar
7. Füzéry, AK, Kost, GJ. Point-of-care testing practices, failure modes, and risk-mitigation strategies in emergency medical services programs in the Canadian province of alberta. Arch Pathol Lab Med 2020;144:1352–71.10.5858/arpa.2020-0268-OASearch in Google Scholar PubMed
8. di Serio, F, Petronelli, MA, Sammartino, E. Laboratory testing during critical care transport: point-of-care testing in air ambulances. Clin Chem Lab Med 2010;48:955–61, https://doi.org/10.1515/CCLM.2010.190.Search in Google Scholar PubMed
9. Vos, G, Engel, M, Ramsay, G, van Waardenburg, D. Point-of-care blood analyzer during the interhospital transport of critically ill children. Eur J Emerg Med 2006;13:304–7, https://doi.org/10.1097/00063110-200610000-00013.Search in Google Scholar PubMed
10. Patel, K, Suh-Lailam, BB. Implementation of point-of-care testing in a pediatric healthcare setting. Crit Rev Clin Lab Sci 2019;56:239–46, https://doi.org/10.1080/10408363.2019.1590306.Search in Google Scholar PubMed
11. Wiencek, J, Nichols, J. Issues in the practical implementation of POCT: overcoming challenges. Expert Rev Mol Diagn 2016;16:415–22, https://doi.org/10.1586/14737159.2016.1141678.Search in Google Scholar PubMed
12. Schober, P, Bossers, SM, Krage, R, de Leeuw, MA, Schwarte, LA. Portable blood (gas) analyzer in a helicopter emergency medical service. Air Med J 2019;38:302–4, https://doi.org/10.1016/j.amj.2019.04.006.Search in Google Scholar PubMed
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2022-0011).
© 2022 Walter de Gruyter GmbH, Berlin/Boston
