title: Arterial line in prehospital emergency settings - A feasibility study in four physician-staffed emergency medical systems.
abstract: OBJECTIVE
  Arterial lines are widely used in operating rooms, critical care and emergency departments. Although invasive arterial blood pressure monitoring and arterial blood gas analysis are prehospitally available, the use of arterial lines in the field remains an exception. This study evaluates the feasibility, indications and therapeutic consequences of prehospital arterial line insertion.
  
  
  METHODS
  Prospective observational study in four physician-staffed emergency medical systems (EMS), documenting patient status, indications, location of puncture, number of tries and time for puncture and therapeutic consequences.
  
  
  RESULTS
  During the one-year observation period, arterial line placement succeeded in 115 (83.9%) of 137 patients. The median time for successful arterial cannulation was 2 min (IQR 1, 3 min; range: 30-600s), for preparing the invasive blood pressure monitoring 3 min (IQR 2, 4 min, range: 30-600s). Main indications were cardiopulmonary resuscitation (36.5%), post-resuscitation care (16.8%), respiratory insufficiency (24.1%) and unconsciousness (22.6%). Therapeutic consequences depended on whether the EMS was equipped with a blood gas analyzer or not and were, overall, reported in 51.3% of patients: fluids, vasoactive or antihypertensive therapy, correction of ventilation or acidosis. No complications occurred during the prehospital phase.
  
  
  CONCLUSIONS
  The insertion of arterial lines is feasible under prehospital conditions, without delaying or complicating patient care. Indications originating from intrahospital use are also valid in the field. In particular when combined with arterial blood gas measurement, the use of arterial lines often leads to important therapeutic consequences.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. gernot.wildner@medunigraz.at
authors.forename: Gernot
authors.initials: G
authors.lastname: Wildner
authors.forename: Nina
authors.initials: N
authors.lastname: Pauker
authors.forename: Sylvia
authors.initials: S
authors.lastname: Archan
authors.forename: Geza
authors.initials: G
authors.lastname: Gemes
authors.forename: Marcel
authors.initials: M
authors.lastname: Rigaud
authors.forename: Mirjam
authors.initials: M
authors.lastname: Pocivalnik
authors.forename: Gerhard
authors.initials: G
authors.lastname: Prause
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria; D001784:Blood Gas Analysis; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods*; D004638:Emergency Treatment / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D010820:Physicians / Q000600:supply & distribution; D011446:Prospective Studies; D015996:Survival Rate; D017749:Total Quality Management; D016896:Treatment Outcome