Mind the GAHP: A novel protocol for improved vascular access in the hypotensive patient.

Autor:	Saab MA; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA.; Brooke Army Medical Center, 3551 Roger Brooke Dr. San Antonio, TX 78234, USA., Raetz EL; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA.; Brooke Army Medical Center, 3551 Roger Brooke Dr. San Antonio, TX 78234, USA., Lowe JB; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA.; Brooke Army Medical Center, 3551 Roger Brooke Dr. San Antonio, TX 78234, USA., Hudson IL; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA.; Brooke Army Medical Center, 3551 Roger Brooke Dr. San Antonio, TX 78234, USA., Jacobson EJ; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA.; Brooke Army Medical Center, 3551 Roger Brooke Dr. San Antonio, TX 78234, USA., Long AN; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA.; Brooke Army Medical Center, 3551 Roger Brooke Dr. San Antonio, TX 78234, USA., Achay JA; Centre for Emergency Health Sciences, 353 Rodeo Dr, Spring Branch, TX 78070, USA., Bolleter SD; Centre for Emergency Health Sciences, 353 Rodeo Dr, Spring Branch, TX 78070, USA., McCuller CA; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA., Rayas EG; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA., Nunnery AM; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA., Bierle RP; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA., Rahm SJ; Centre for Emergency Health Sciences, 353 Rodeo Dr, Spring Branch, TX 78070, USA., Epley EA; Centre for Emergency Health Sciences, 353 Rodeo Dr, Spring Branch, TX 78070, USA., Poe RJ; Centre for Emergency Health Sciences, 353 Rodeo Dr, Spring Branch, TX 78070, USA., DeSoucy ES; Brooke Army Medical Center, 3551 Roger Brooke Dr. San Antonio, TX 78234, USA., De Lorenzo RA; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA., Dumas RP; University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA., Paxton JH; Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA., Rogerson TC; Sir Charles Gairdner Hospital, Hospital Ave, Nedlands WA 6009, Australia., Georgoff PE; Duke University, 2301 Erwin Rd, Durham, NC 27710, USA., Adema AL; University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA., Eng Hock Ong M; Duke-National University of Singapore Medical School, 8 College Rd, 16985, Singapore.; Singapore General Hospital, Outram Rd, 169608, Singapore., Wampler DA; University of Texas Health Science Center San Antonio, 4502 Medical Dr, San Antonio, TX 78229, USA.
Jazyk:	angličtina
Zdroj:	Resuscitation plus [Resusc Plus] 2024 Jul 16; Vol. 19, pp. 100714. Date of Electronic Publication: 2024 Jul 16 (Print Publication: 2024).
DOI:	10.1016/j.resplu.2024.100714
Abstrakt:	Background: Obtaining intravenous access in hypotensive patients is challenging and may critically delay resuscitation. The Graduated Vascular Access for Hypotensive Patient (GAHP) protocol leverages intraosseous fluid boluses to specifically dilate proximal veins. This study aims to evaluate the efficacy of GAHP in maximizing venous targets through early distal intraosseous access and a small fluid bolus. Methods: This was a prospective randomized cadaveric pilot study to evaluate extremity venous engorgement during intraosseous infusion. Cadavers (n = 23) had an intraosseous needle inserted into four sites: distal radius, proximal humerus, distal femur, and distal tibia. Intraosseous saline was rapidly infused, venous optimization was measured using real-time ultrasound. Primary outcome was maximum vessel circumference increase with intraosseous infusion. Secondary outcomes were: time to maximum circumference, and infusion volume required. Statistical analyses included Levene's test for equality of variances, Wilcoxon signed-rank test, and generalized estimating equation. Results: There was a significant mean increase of 1.03 cm (95% CI 0.86, 1.20), representing a difference of 102%. We found no significant difference in time to optimize vessel circumference across sites, but volume required significantly differed. Conclusion: GAHP quickly and effectively increased the circumference of anatomically adjacent veins. Anatomical sites did not differ on time to reach maximum enlargement of vessels following intraosseous infusion but did differ in terms of volume required to maximize vessel circumference. Further research is needed using live, hypotensive patients. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Crown Copyright © 2024 Published by Elsevier B.V.)
Databáze:	MEDLINE
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