title: Time delays associated with vasoactive medication preparation and delivery in simulated patients at risk of cardiac arrest.
abstract: To compare, quantify, and describe the time-delays associated with four common methods of adrenaline administration in the simulated setting of impending cardiac arrest.
  
  
  
  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.
  
  
  
  Median total delay was i) 120s for bolus (95% CI 112-128s); ii) 179s for lower concentration infusion (95% CI 172-186s); iii) 296s for higher concentration infusion (95% CI 285-307s); and iv) 411s for higher concentration infusion plus carrier line (95% CI 399-423s). 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.
  
  
  
  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.
authors.affiliation: Critical Care Medicine, Medical Ethics, Anesthesiology, University of Alberta Hospital, Edmonton, Alberta T6G2B7, Canada. Electronic address: brindley@ualberta.ca.
authors.forename: P G
authors.initials: PG
authors.lastname: Brindley
authors.affiliation: Shock Trauma Air Rescue Society, Emergency Departments Edmonton Zone, RM 1G1:55, Department of Emergency Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada. Electronic address: domhnall.odochartaigh@ahs.ca.
authors.forename: D
authors.initials: D
authors.lastname: O'Dochartaigh
authors.affiliation: Saba University School of Medicine Dutch Caribbean, Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Volney
authors.affiliation: Shock Trauma Air Rescue Service, Edmonton, Alberta, Canada. Electronic address: sryan@stars.ca.
authors.forename: S
authors.initials: S
authors.lastname: Ryan
authors.affiliation: Royal Alexandra Hospital Emergency Department, Edmonton, Alberta, Canada. Electronic address: matthew.douma@AHS.ca.
authors.forename: M J
authors.initials: MJ
authors.lastname: Douma
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D018592:Cross-Over Studies; D004339:Drug Compounding; D016529:Emergency Nursing / Q000592:standards; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D000066908:Simulation Training; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine