Presence of an arterial line improves response to simulated hypotension and pulseless electrical activity

Jonathan Lipps, Andrew Goldberg, Samuel DeMaria, Yury Khelemsky, Adam Levine, Vedat Yildiz, Bryan Mahoney

With pulseless electrical activity (PEA) emerging as one of the leading cardiac arrest arrhythmias, the rapid response and accurate diagnosis of PEA is essential to improve survival rates. Although the use of invasive blood pressure monitoring to more quickly detect changes in blood pressure is widespread, evidence for its use is largely anecdotal and placement is not without risk. This is a prospective, multi-center, randomized controlled trial involving 58 senior anesthesiology residents undergoing a simulation of intraoperative PEA using high-fidelity simulation. Of the total 58 participants, 28 subjects were randomized to invasive blood pressure monitoring and 30 to non-invasive blood pressure monitoring in order to investigate the effects of arterial line information on the response time of ACLS-trained anesthesiology residents. Response times of subjects in the group provided with invasive blood pressure monitoring were faster to palpate pulses (6.5 s faster, p = .0470), initiate chest compressions (17 s faster, p = .004), and administer 1 mg of epinephrine (21 s faster, p = .0005. The absolute number of pharmacologic interventions was increased in the group with invasive blood pressure monitoring (p = .020). These findings suggest that noninvasive blood pressure monitoring and other readily available monitors are not as powerful as invasive blood pressure monitoring in influencing decision-making during a PEA event. As there is currently no specific blood pressure at which the patient is considered to be in PEA, future studies are necessary to clarify the correlation between the arterial line tracing and the appropriate trigger for ACLS initiation.