Choosing a Vasopressor for a Prehospital Emergency Medical System: Consideration for Agent Selection and Review of Pharmacologic Profiles, Efficacy, and Safety in Treatment of Shock. WMJ 2020 Dec;119(4):240-247
Date
01/12/2021Pubmed ID
33428833Scopus ID
2-s2.0-85099890579 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
INTRODUCTION: Prehospital medical teams encounter patients with varying states of shock that require the use of vasopressors for hemodynamic support during transport. Selection of a vasopressor is challenging due to the absent comparative literature in prehospital medicine, as well as practical limitation of use in an ambulance.
AREAS COVERED: This article discusses specific challenges in the delivery of vasopressor support for hemodynamically compromised patients in the prehospital environment. Discussion includes the current state of vasopressor use in prehospital medicine, use of a patient-specific agent selection or "one-vasopressor-fits-all" modality, as well as considerations for each vasopressor based on practical, pharmacologic, and comparative evidence-based evaluations.
CONCLUSIONS: There are currently many limitations to assessment of shock etiology in the prehospital setting. A "one-vasopressor-fits-all" strategy may be most feasible for most prehospital emergency medical services (EMS) systems. No clear difference in extravasation exists amongst agents. Based on current evidence, norepinephrine may be more efficacious and have a better safety profile than other vasopressors in cardiogenic, distributive, and neurogenic shocks. Due to its suitability for most shocks, norepinephrine is a reasonable agent for EMS systems to employ as a "one-size-fits-all" vasopressor.
Author List
Feldman R, Stanton M, Chinn M, Grawey T, Weston BAuthors
Matthew Chinn MD Associate Professor in the Emergency Medicine department at Medical College of WisconsinRyan J. Feldman PharmD Adjunct Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin
Tom Grawey DO Assistant Professor in the Emergency Medicine department at Medical College of Wisconsin
Matthew Stanton PharmD Adjunct Associate Professor in the School of Pharmacy Administration department at Medical College of Wisconsin
Benjamin Weston MD, MPH Associate Professor in the Emergency Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Emergency Medical ServicesEmergency Service, Hospital
Humans
Vasoconstrictor Agents