title: Presence of an arterial line improves response to simulated hypotension and pulseless electrical activity.
abstract: With pulseless electrical activity (PEA) emerging as one of the leading cardiac arrest arrhythmias, the rapid response and accurate diagnosis of PEA is essential to improve survival rates. Although the use of invasive blood pressure monitoring to more quickly detect changes in blood pressure is widespread, evidence for its use is largely anecdotal and placement is not without risk. This is a prospective, multi-center, randomized controlled trial involving 58 senior anesthesiology residents undergoing a simulation of intraoperative PEA using high-fidelity simulation. Of the total 58 participants, 28 subjects were randomized to invasive blood pressure monitoring and 30 to non-invasive blood pressure monitoring in order to investigate the effects of arterial line information on the response time of ACLS-trained anesthesiology residents. Response times of subjects in the group provided with invasive blood pressure monitoring were faster to palpate pulses (6.5 s faster, p = .0470), initiate chest compressions (17 s faster, p = .004), and administer 1 mg of epinephrine (21 s faster, p = .0005. The absolute number of pharmacologic interventions was increased in the group with invasive blood pressure monitoring (p = .020). These findings suggest that noninvasive blood pressure monitoring and other readily available monitors are not as powerful as invasive blood pressure monitoring in influencing decision-making during a PEA event. As there is currently no specific blood pressure at which the patient is considered to be in PEA, future studies are necessary to clarify the correlation between the arterial line tracing and the appropriate trigger for ACLS initiation.
authors: Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA. jonathan.lipps@osumc.edu.
authors: Jonathan
authors: http://orcid.org/0000-0002-1749-9894
authors: J
authors: Lipps
authors: Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Andrew
authors: A
authors: Goldberg
authors: Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Samuel
authors: S
authors: DeMaria
authors: Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Yury
authors: Y
authors: Khelemsky
authors: Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Adam
authors: A
authors: Levine
authors: Department of Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors: Vedat
authors: V
authors: Yildiz
authors: Department of Anesthesiology, Icahn School of Medicine at Mount Sinai/St Luke's-Roosevelt Hospital Center, New York, NY, USA.
authors: Bryan
authors: B
authors: Mahoney
mesh_terms: D000368:Aged; D000776:Anesthesiology / Q000379:methods*; D001794:Blood Pressure; D001795:Blood Pressure Determination; D016887:Cardiopulmonary Resuscitation; D003198:Computer Simulation; D018450:Disease Progression; D055724:Electrophysiological Phenomena; D006323:Heart Arrest / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D009873:Operating Rooms; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors
keywords: Anesthesia; Arterial line; Cardiac arrest; Hypotension; Invasive monitoring; Simulation