A national survey of medication utilization for cardiac resuscitation in the emergency department: A survey of emergency medicine pharmacists

Author:

Ray Lance12,Acquisto Nicole M34,Coralic Zlatan5,Feldman Ryan67,Mercer Kevin89,Zimmerman David E1011,Howington Gavin T1213,Slocum Giles W1415,Faine Brett1617,Rech Megan A1819

Affiliation:

1. Department of Pharmacy, Denver Health and Hospital Authority , Denver, CO

2. Department of Emergency Medicine, University of Colorado , Aurora, CO , USA

3. Department of Pharmacy, University of Rochester Medical Center , Rochester, NY

4. Department of Emergency Medicine, University of Rochester Medical Center , Rochester, NY , USA

5. University of California San Francisco , San Francisco, CA , USA

6. Froedtert Hospital , Milwaukee, WI

7. Department of Clinical Sciences , Milwaukee, WI , USA

8. The University of Texas at Austin College of Pharmacy , Austin, TX

9. Department of Pharmacy, Houston Methodist West Hospital , Houston, TX , USA

10. Duquesne University School of Pharmacy , Pittsburgh, PA

11. University of Pittsburgh Medical Center–Mercy , Pittsburgh, PA , USA

12. Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy , Lexington, KY

13. Department of Pharmacy Services, University of Kentucky HealthCare , Lexington, KY , USA

14. Department of Pharmacy, Rush University Medical Center , Chicago, IL

15. Department of Emergency Medicine, Rush University Medical Center , Chicago, IL , USA

16. Department of Emergency Medicine, University of Iowa , Iowa City, IA

17. Department of Pharmacy, University of Iowa , Iowa City, IA , USA

18. Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital , Hines, IL

19. Department of Emergency Medicine, Loyola University Medical Center , Maywood, IL , USA

Abstract

Abstract Purpose Vasoactive medications are used during advanced cardiac life support (ACLS) to shunt oxygenated blood to vital organs and after return of spontaneous circulation (ROSC) to maintain hemodynamic goals. However, limited evidence exists to support vasoactive medication recommendations in such scenarios, and it is unknown how practices vary among emergency departments across the US. Methods A survey questionnaire (15 questions) was electronically distributed to emergency medicine pharmacists (EMPs) in the US through various professional listservs. Demographic information, American Heart Association ACLS algorithm medication use, and use of continuous vasopressor infusions and adjunct medications following ROSC were assessed and are reported descriptively. Results The survey was distributed to 764 EMPs, with a 23% response rate from a wide geographic distribution and 48% of respondents practicing in academic medical centers. Epinephrine dosing and administration during cardiac arrest were reported by most to be in accordance with ACLS cardiac arrest algorithms. Calcium, magnesium sulfate, and sodium bicarbonate were the most common adjunct intravenous medications given during cardiac arrest. Norepinephrine was the first-choice vasopressor (81%) for post-ROSC hypotension, while epinephrine was preferred less frequently (17%). Antibiotics and sodium bicarbonate were the most frequently administered post-ROSC adjunct medications. Conclusion This survey of a geographically diverse group of EMPs demonstrated high ACLS algorithm adherence for epinephrine during cardiac arrest with frequent additional administration of nonalgorithm medications. Sodium bicarbonate and calcium were the most frequently administered adjunct medications during cardiac arrest, while sodium bicarbonate and antibiotics were the most frequently used adjunct medications following ROSC. Norepinephrine was the most commonly used vasopressor following ROSC.

Publisher

Oxford University Press (OUP)

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