Michael Berkenbush, Nicholas Sherman, Nikhil Jain, Peter Cosmi
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We also analyzed if a patient received a second bolus within 60 min of arrival to the ED.</p><p><strong>Methods: </strong>We used a retrospective propensity-matched cohort of prehospital patients with atrial fibrillation for whom diltiazem was administered, from 1/1/2018 to 12/31/2021, in our system of 10 New Jersey paramedic units. We analyzed the age, gender, and initial HR and used it to match groups. We analyzed the mode and time of administration, dosage of the bolus, and presence of hypotension prehospitally.</p><p><strong>Results: </strong>The matched groups contained 145 patients who received a prehospital diltiazem bolus only (BO) and 146 patients who received a diltiazem bolus and infusion (BI). There was no significant difference between the mean change in HR from initial paramedic arrival to ED arrival between the two groups (BO 38 vs. BI 34, <i>p</i> = 0.16). There was no significant difference in the need for a second bolus within the first 60 min of arrival to the ED (BO 9.7% vs. BI 11.6%, <i>p</i> = 0.30). Patients in the BO group were more likely to experience prehospital hypotension then in the BI group (BO 17.2% vs BI 8.2%, <i>p</i> = 0.01), despite receiving smaller initial bolus doses (BO 14.2 mg vs. BI 17.4 mg, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Our results show no significant differences in HR control or need for repeat bolus at the ED with the use of a diltiazem infusion following a diltiazem bolus. However, even when administering larger boluses, the use of an infusion pump resulted in less hypotension.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":2.1000,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prehospital Treatment of Atrial Fibrillation: Infusion Pump for Bolus and Infusion?\",\"authors\":\"Michael Berkenbush, Nicholas Sherman, Nikhil Jain, Peter Cosmi\",\"doi\":\"10.1080/10903127.2024.2349745\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The prehospital treatment for stable patients with atrial fibrillation with rapid ventricular response is rate-controlling agents such as calcium channel blockers, often diltiazem given as a bolus. At our agency we encourage the use of a bolus given via the infusion pump over two to four minutes immediately followed by a maintenance infusion, given concerns of recurrent tachycardia or hypotension secondary to rapid bolus administration. We examined if administering a bolus and infusion via an infusion pump shows better heart rate (HR) control at arrival to the emergency department (ED) compared with administration of a bolus only, while maintaining hemodynamic stability during transport. We also analyzed if a patient received a second bolus within 60 min of arrival to the ED.</p><p><strong>Methods: </strong>We used a retrospective propensity-matched cohort of prehospital patients with atrial fibrillation for whom diltiazem was administered, from 1/1/2018 to 12/31/2021, in our system of 10 New Jersey paramedic units. We analyzed the age, gender, and initial HR and used it to match groups. We analyzed the mode and time of administration, dosage of the bolus, and presence of hypotension prehospitally.</p><p><strong>Results: </strong>The matched groups contained 145 patients who received a prehospital diltiazem bolus only (BO) and 146 patients who received a diltiazem bolus and infusion (BI). There was no significant difference between the mean change in HR from initial paramedic arrival to ED arrival between the two groups (BO 38 vs. BI 34, <i>p</i> = 0.16). There was no significant difference in the need for a second bolus within the first 60 min of arrival to the ED (BO 9.7% vs. BI 11.6%, <i>p</i> = 0.30). Patients in the BO group were more likely to experience prehospital hypotension then in the BI group (BO 17.2% vs BI 8.2%, <i>p</i> = 0.01), despite receiving smaller initial bolus doses (BO 14.2 mg vs. BI 17.4 mg, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Our results show no significant differences in HR control or need for repeat bolus at the ED with the use of a diltiazem infusion following a diltiazem bolus. 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引用次数: 0
摘要
目的:对于心房颤动病情稳定、心室反应迅速的患者,院前治疗方法是使用钙通道阻滞剂等心率控制药物,通常使用地尔硫卓作为栓剂。考虑到快速给药会导致心动过速或低血压复发,我们鼓励通过输液泵在两到四分钟内给予栓剂,然后立即进行维持性输注。我们研究了通过输液泵给予栓剂和输液与仅给予栓剂相比,是否能在到达急诊科(ED)时更好地控制心率(HR),同时在转运过程中保持血液动力学稳定。我们还分析了患者在到达急诊科 60 分钟内是否接受了第二次栓剂注射:我们使用了一个回顾性倾向匹配队列,该队列包含了从 2018 年 1 月 1 日至 2021 年 12 月 31 日期间在新泽西州 10 个辅助医疗单位系统中使用地尔硫卓的院前心房颤动患者。我们分析了患者的年龄、性别和初始心率,并以此进行分组匹配。我们分析了给药的方式和时间、栓剂的剂量以及临终前是否出现低血压:结果:配对组中有 145 名患者仅接受了院前地尔硫卓栓剂(BO),146 名患者接受了地尔硫卓栓剂和输液(BI)。两组患者从医护人员到达到急诊室的平均心率变化无明显差异(BO 38 vs. BI 34,p = 0.16)。在到达急诊室后的 60 分钟内需要第二次注射的比例没有明显差异(BO 组 9.7% 对 BI 组 11.6%,P = 0.30)。尽管初始栓剂剂量较小(BO 14.2 毫克 vs. BI 17.4 毫克,p),但BO 组患者发生院前低血压的几率比 BI 组高(BO 17.2% vs. BI 8.2%,p = 0.01):我们的研究结果表明,在使用地尔硫卓栓剂后输注地尔硫卓,与在急诊室使用地尔硫卓栓剂在心率控制或重复栓剂的需求方面没有明显差异。不过,即使在给药量较大的情况下,使用输液泵也能减少低血压的发生。
Prehospital Treatment of Atrial Fibrillation: Infusion Pump for Bolus and Infusion?
Objective: The prehospital treatment for stable patients with atrial fibrillation with rapid ventricular response is rate-controlling agents such as calcium channel blockers, often diltiazem given as a bolus. At our agency we encourage the use of a bolus given via the infusion pump over two to four minutes immediately followed by a maintenance infusion, given concerns of recurrent tachycardia or hypotension secondary to rapid bolus administration. We examined if administering a bolus and infusion via an infusion pump shows better heart rate (HR) control at arrival to the emergency department (ED) compared with administration of a bolus only, while maintaining hemodynamic stability during transport. We also analyzed if a patient received a second bolus within 60 min of arrival to the ED.
Methods: We used a retrospective propensity-matched cohort of prehospital patients with atrial fibrillation for whom diltiazem was administered, from 1/1/2018 to 12/31/2021, in our system of 10 New Jersey paramedic units. We analyzed the age, gender, and initial HR and used it to match groups. We analyzed the mode and time of administration, dosage of the bolus, and presence of hypotension prehospitally.
Results: The matched groups contained 145 patients who received a prehospital diltiazem bolus only (BO) and 146 patients who received a diltiazem bolus and infusion (BI). There was no significant difference between the mean change in HR from initial paramedic arrival to ED arrival between the two groups (BO 38 vs. BI 34, p = 0.16). There was no significant difference in the need for a second bolus within the first 60 min of arrival to the ED (BO 9.7% vs. BI 11.6%, p = 0.30). Patients in the BO group were more likely to experience prehospital hypotension then in the BI group (BO 17.2% vs BI 8.2%, p = 0.01), despite receiving smaller initial bolus doses (BO 14.2 mg vs. BI 17.4 mg, p < 0.001).
Conclusion: Our results show no significant differences in HR control or need for repeat bolus at the ED with the use of a diltiazem infusion following a diltiazem bolus. However, even when administering larger boluses, the use of an infusion pump resulted in less hypotension.
期刊介绍:
Prehospital Emergency Care publishes peer-reviewed information relevant to the practice, educational advancement, and investigation of prehospital emergency care, including the following types of articles: Special Contributions - Original Articles - Education and Practice - Preliminary Reports - Case Conferences - Position Papers - Collective Reviews - Editorials - Letters to the Editor - Media Reviews.