Ule Jakob, Hüppe Tobias, Thiel Julian, Berwanger Ulrich, Schlechtriemen Thomas, Conrad David, Merscher Benedikt
Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Kirrberger Straße 100, Homburg (Saar), 66421, Germany.
Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Marienhaus Clinic St. Elisabeth Saarlouis, Kapuzinerstraße 4, Saarlouis, 66740, Germany.
Scand J Trauma Resusc Emerg Med. 2025 Sep 2;33(1):145. doi: 10.1186/s13049-025-01461-9.
Exposure to hypotension is linked to increased morbidity and mortality. Invasive blood pressure (IBP) measurement might be superior to non-invasive blood pressure measurement in detecting hypotension. The feasibility of IBP in prehospital care for selected patients by specialized rescue teams has been demonstrated. Therefore, we tested the hypothesis that the implementation of prehospital IBP measurement is feasible in a German emergency system by emergency teams with limited exposure to critically ill patients.
This single center study was conducted with two emergency physicians vehicles. Indications for IBP measurement were adults requiring airway management, catecholamine therapy or fluid resuscitation. IBP was performed using either direct or Seldinger technique. Physicians recorded the puncture attempts, cannulation sites, and techniques. Patients with IBP attempt were visited the first three days to report complications. Emergency physicians documented a reason if they decided not to perform IBP. Data were analyzed to find operational differences between IBP attempts and no IBP attempts and IBP success and failure. Multiple linear regression was used to measure the influence of prehospital IBP attempts on the on-scene time.
During the study period, 3887 emergency responses occurred, with 2.8% (n = 108) meeting IBP criteria. Reasons for an IBP were catecholamine therapy (74%), airway management (73%) and fluid resuscitation (51%). 68 (63%) of the patients meeting IBP criteria received an IBP attempt with a success rate of 88%. While difficult extrication (p = 0.002) and longer transportation time (p = 0.009) were associated with a high IBP attempt rate, IBP attempts in nursing homes were less often performed (p = 0.002). Most common reason for not performing IBP was a transport priority and poor puncturing condition. Multiple regression analysis showed IBP attempts prolonged the on-scene time by 7.4 min (p = 0.013).
Prehospital IBP can be performed safely even by teams with limited exposure to critically ill patients, with low failure and complication rates across a wide range of indications. Based on these data, IBP measurement prolonged the on-scene time by 7.5 min. Even though exposure to critically ill patients is rare, teams should consider performing an IBP if indicated.
Study was a part of the PHINIABP (PreHospital Invasive vs. Non-Invasive Blood Pressure) study and was registered with German Clinical Trials (ID DRKS00030477) and approved by the regional ethics committee (Ärztekammer Saarland, Saarbrücken, Germany, Identification Number 158/22, September 13, 2022). Written informed consent was obtained from patients or their legal representatives.
低血压暴露与发病率和死亡率增加有关。在检测低血压方面，有创血压（IBP）测量可能优于无创血压测量。专门救援团队对选定患者进行院前有创血压测量的可行性已得到证实。因此，我们检验了以下假设：在德国急诊系统中，由接触危重症患者机会有限的急救团队进行院前有创血压测量是可行的。
本单中心研究使用两辆急救医生车辆进行。有创血压测量的指征为需要气道管理、儿茶酚胺治疗或液体复苏的成人患者。有创血压测量采用直接法或塞丁格技术。医生记录穿刺尝试次数、置管部位和技术。对尝试进行有创血压测量的患者在头三天进行随访以报告并发症。如果急救医生决定不进行有创血压测量，需记录原因。分析数据以找出有创血压测量尝试与未进行有创血压测量尝试以及有创血压测量成功与失败之间的操作差异。使用多元线性回归来衡量院前有创血压测量尝试对现场停留时间的影响。
在研究期间，共发生3887次急救响应，其中2.8%（n = 108）符合有创血压测量标准。进行有创血压测量的原因包括儿茶酚胺治疗（74%）、气道管理（73%）和液体复苏（51%）。符合有创血压测量标准的患者中有68例（63%）接受了有创血压测量尝试，成功率为88%。虽然困难解救（p = 0.002）和较长转运时间（p = 0.009）与高有创血压测量尝试率相关，但在养老院进行有创血压测量尝试的情况较少（p = 0.002）。不进行有创血压测量的最常见原因是运输优先级和穿刺条件差。多元回归分析显示，有创血压测量尝试使现场停留时间延长了7.4分钟（p = 0.013）。
即使是接触危重症患者机会有限的团队，也能安全地进行院前有创血压测量，在广泛的指征范围内失败率和并发症率较低。基于这些数据，有创血压测量使现场停留时间延长了7.5分钟。尽管接触危重症患者的情况很少见，但如果有指征，团队应考虑进行有创血压测量。
本研究是PHINIABP（院前有创与无创血压）研究的一部分，已在德国临床试验注册（ID DRKS00030477），并获得地区伦理委员会（德国萨尔布吕肯萨尔州医师协会，识别号158/22，2022年9月13日）批准。已获得患者或其法定代表人的书面知情同意。
