Safety of Peripheral Vasoactive Drug Administration in Prehospital and Retrieval Medicine ( <scp>SPOTLESS</scp> ‐2): A Prospective Observational Cohort Study

INTRODUCTION: Adrenaline and noradrenaline are cornerstones of critical care. Traditionally, delivery of these drugs has been through central venous access due to concerns over the safety of peripheral venous access. However, central venous access also may lead to delays and complications, so there is increasing use of peripheral vasoactive drugs. There is evidence for the safety of peripheral administration in controlled theatre and intensive care settings but limited evidence in Prehospital and Retrieval Medicine. METHODS: We conducted a prospective, observational cohort study including patients transferred by Lifeflight Medicine from April 2022 to August 2023. The primary outcome was to establish the safety of peripheral adrenaline and noradrenaline. Patients receiving adrenaline or noradrenaline via peripheral intravenous cannula were included and data on venous access, drug delivery, and complications during transfer was collected. Patients were followed to 24 h post arrival to the receiving facility. RESULTS: A total of 656 patients were screened, 468 met the inclusion criteria. Patients were predominantly men (60%), median age of 64, 74% of patients were transferred by rotary wing. Noradrenaline was the most common infusion (72%) with a median dose of 0.1 μg/kg/min, and 0.13 μg/kg/min for adrenaline. The anterior cubital fossa was the most common infusion site (78%). Septic shock was the most common indication (47%). The median duration of infusion was 85 min. 93.4% of patients experienced no events with the peripheral infusion; of the remaining 31 patients, 13 (2.8%) had minor technical issues with drug delivery, 14 (3%) had minor complications affecting patient care and 4 (0.8%) required conversion to central access in transit. There were no tissue complications at 24 h follow-up. CONCLUSION: Our data suggests that adrenaline and noradrenaline may be safely administered peripherally in Prehospital and Retrieval Medicine environments, with a low overall risk of complications. TRIAL REGISTRATION: The study was pre-registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12622000404729).