From Ambulance to Admission

OBJECTIVE: Vasopressors are critical for patients experiencing shock. This observational study aims to describe the usage of vasopressors by EMS, and to assess how vasopressor usage differs between transport and hospital environments. The information gathered in this study can help determine which vasopressors should be available in an EMS system and guide the management of patients requiring vasopressors during EMS transport. METHODS: A retrospective observation study was performed from December 2019 to December 2022. Inclusion criteria were adult patients who received vasopressor infusions during transport by the Mayo Clinic Ambulance Service. These patients were followed up to 12 hours after hospital admission to determine which vasopressors they received after hospital admission. RESULTS: A total of 1212 patients were enrolled in this study. The vasopressor most used was norepinephrine, which was administered to 1081 (89.2%) patients. Epinephrine was administered to 163 (13.4%) patients. Vasopressin was administered to 103 (8.5%) patients, while 60 (5.0%) received dopamine. In total, 505 (41.7%) of patients received multiple vasopressors during EMS transport. Most patients who received vasopressors during transport continued to require vasopressors six hours after admission (n = 836, 69.0%). High-dose norepinephrine, defined as infusions higher than 0.3 μg/kg/min, was administered to 108 (10.7%) patients during transport, 39 (5.5%) patients six hours after admission, and 16 (2.5%) patients 12 hours after admission. For these patients requiring high-dose norepinephrine, supplemental vasopressors were used in 51 (47%) patients during transport, 33 (85%) patients six hours after admission, and 14 (88%) patients 12 hours after admission.