Goldilocks in cardiac arrest: A scoping review of invasive hemodynamic monitoring in the pre-hospital setting for getting adrenaline dosing just right

Abstract

Introduction A one-size-fits-all approach to adrenaline dosing is likely to be sub-optimal for out-of-hospital cardiac arrest given the diverse nature of patient age, bodyweight, frailty and intra-arrest coronary perfusion pressure. An individualised adrenaline dosing approach to cardiac arrest using invasive blood pressure monitoring has been shown to increase rates of return of spontaneous circulation in the hospital setting, but evidence for this approach has not yet been reviewed in the pre-hospital setting. Methods A scoping review was undertaken using Science Direct, ProQuest, PubMed, CINAHL Complete and GALE Health and Wellness databases with the search terms ‘arterial line’, ‘pre-hospital’, ‘cardiac arrest’ and similar derivatives. Subject matter experts and authors of articles meeting inclusion criteria were also consulted to help identify further relevant studies. Articles were included if they pertained to the use of arterial lines in cardiac arrest in the pre-hospital field, and excluded if they related to traumatic cardiac arrest, in a language other than English, Dutch or French, or not retrievable as a full text. Results A total of 1408 articles were identified using the search method, of which three remained after de-duplication, use of inclusion and exclusion criteria, and full text appraisal. The current pre-hospital literature is lacking and avenues for further research to improve the evidence for hemodynamic guided resuscitation were identified. Conclusion Paramedic-initiated invasive arterial monitoring presents a new, but as yet unproven, intervention for improving cardiac arrest outcomes.