Time delays associated with vasoactive medication preparation and delivery in simulated patients at risk of cardiac arrest

Purpose: To compare, quantify, and describe the time-delays associated with four common methods of adrenaline administration in the simulated setting of impending cardiac arrest.

Methods: 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.

Results: 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.

Conclusions: 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.