scholarly journals Point-of-Care Testing in Out-of-Hospital Cardiac Arrest: A Retrospective Analysis of Relevance and Consequences

2021 ◽  
Author(s):  
Tobias Gruebl ◽  
Birgit Ploeger ◽  
Erich Wranze-Bielefeld ◽  
Markus Mueller ◽  
Willi Schmidbauer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Treatment Time ◽  
Point Of Care ◽  
Venous Blood ◽  
Hospital Setting ◽  
Hospital Treatment ◽  
Point Of Care Testing ◽  
Study Region ◽  
Probability Of Survival ◽  
Arterial Blood

Abstract BackgroundMetabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT).MethodsWe conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient’s eventual outcome.ResultsN=263 pre-hospital resuscitations were included and in n=98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH<7.2+BE<-5mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (>6.0mmol/l / <2.5mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (+/- 20) min without POCT and 60 (+/- 17) min with POCT (p=0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p=0.01).Conclusions Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid-base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.

scholarly journals Point-of-care testing in out-of-hospital cardiac arrest: a retrospective analysis of relevance and consequences

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Tobias Gruebl ◽  
B. Ploeger ◽  
E. Wranze-Bielefeld ◽  
M. Mueller ◽  
W. Schmidbauer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Treatment Time ◽  
Point Of Care ◽  
Venous Blood ◽  
Hospital Setting ◽  
Hospital Treatment ◽  
Point Of Care Testing ◽  
Study Region ◽  
Probability Of Survival ◽  
Arterial Blood

Abstract Background Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT). Methods We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient’s eventual outcome. Results N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE <  − 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16). Conclusions Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid–base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.

Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6–59 Months

2020 ◽  
Author(s):  
Gomathi Ramaswamy ◽  
Kashish Vohra ◽  
Kapil Yadav ◽  
Ravneet Kaur ◽  
Tripti Rai ◽  
...  
Keyword(s):  
Point Of Care ◽  
Venous Blood ◽  
Public Health Problem ◽  
Outpatient Department ◽  
Point Of Care Testing ◽  
Adequate Treatment ◽  
Non Invasive ◽  
Hematology Analyzer ◽  
The Mean ◽  
Study Participants

Abstract Introduction Globally around 47.4% of children and in India, 58% of children aged 6–59 months are anemic. Diagnosis of anemia in children using accurate technologies and providing adequate treatment is essential to reduce the burden of anemia. Point-of-care testing (POCT) devices is a potential option for estimation of hemoglobin in peripheral and field settings were the hematology analyzer and laboratory services are not available. Objectives To access the validity of the POCTs (invasive and non-invasive devices) for estimation of hemoglobin among children aged 6–59 months compared with hematology analyzer. Methods The study participants were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. Hemoglobin levels of the study participants were estimated in Sahli’s hemoglobinometer and invasive digital hemoglobinometers (DHs) using capillary blood samples. Hemoglobin levels in non-invasive DH were assessed from the finger/toe of the children. Hemoglobin levels measured in POCTs were compared against the venous blood hemoglobin estimated in the hematology analyzer. Results A total of 120 children were enrolled. The mean (SD) of hemoglobin (g/dl) estimated in auto-analyzer was 9.4 (1.8), Sahli’s hemoglobinometer was 9.2 (1.9), invasive DH was 9.7 (1.9), and non-invasive DH was 11.9 (1.5). Sahli’s hemoglobinometer (95.5%) and invasive DH (92.2%) had high sensitivity for the diagnosis of anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH had higher specificity (96.7%) compared with invasive DH (83.3%) and Sahli’s hemoglobinometer (70%). Invasive DH took the least time (2–3 min) for estimation of hemoglobin per participant, followed by Sahli’s (4–5 min) and non-invasive DH (5–7 min). Conclusion All three POCT devices used in this study are reasonable and feasible for estimating hemoglobin in under-5 children. Invasive DHs are potential POCT devices for diagnosis of anemia among under-5 children, while Sahli’s can be considered as a possible option, where trained and skilled technicians are available. Further research and development are required in non-invasive DH to improve accuracy. Lay summary In India, anemia is a serious public health problem, where 58% of the children aged 6–59 months are anemic. Point-of-care testing (POCT) using digital hemoglobinometers (DHs) has been recommended as one of the key interventions by the Anemia Mukt Bharat program since 2018 in India. These POCT devices are easy to use, less invasive, can be carried to field, require minimal training and results are available immediately. Therefore this study assessed the validity of POCT devices—invasive DH, non-invasive DH and Sahli’s hemoglobinometer among 6–59 months children in facility setting compared with the gold standard hematology analyzer. A total of 120 children under 6–59 months of age were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. The (mean hemoglobin in g/dl) invasive (9.7) and non-invasive DH (11.9) overestimated hemoglobin value, while Sahli’s (9.2) underestimated hemoglobin compared with hematology analyzer (9.4). Invasive DH (92.2%) and Sahli’s hemoglobinometer (95.5%) reported high ability to correctly identify those with anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH (96.73%) had higher ability to correctly identify those without the anemia compared with invasive DH (83.3%) and Sahli’s (70%).

The evaluation of point-of-care testing for determining hemoglobin levels in geriatric intensive care patients

2018 ◽  
Vol 42 (5) ◽  
pp. 189-193
Author(s):  
Tevfik Honca ◽  
Mehtap Honca
Keyword(s):  
Geriatric Patients ◽  
Point Of Care ◽  
Capillary Blood ◽  
Blood Gas ◽  
Gas Analyzer ◽  
Point Of Care Testing ◽  
Arterial Blood ◽  
Hematology Analyzer ◽  
Automated Hematology Analyzer ◽  
Blood Gas Analyzer

AbstractBackgroundThe aim of the present study was to compare hemoglobin (Hb) levels determined by point-of-care testing (POCT) HemoCue® and arterial blood gas analyzer using an automated hematology analyzer in critically ill geriatric patients.MethodsForty geriatric patients requiring intensive care treatment were included in the study. Arterial blood sample was analyzed using HemoCue® (HemoCue®; Hb 201+, Angelholm, Sweden) (HbHemoCueArterial), blood gas analyzer (Techno Medica, Gastat1800 series, Japan) (HbBGA) and an automated hematology analyzer (Cell Dyne 3700 System, Abbott Laboratories, USA) (HbLab) as a reference method. Capillary blood measurements were performed (HbHemoCueCapillary) using HemoCue® at bedside. Bland-Altman analysis was applied to the results.ResultsWe found a positive correlation between the Hb measurements of HemoCueCapillary, HemoCueArterial and automated hematology analyzer (r-values were 0.799 and 0.922, respectively) and p<0.001. There was also a positive correlation between the Hb measurements of blood gas analyzer and automated hematology analyzer (r = 0.878) and p<0.001. The bias and limits of agreement were 0.32 and −2.5±3.14 g/dL for the HbHemoCueCapillary, 0.64 and −1.03±2.31 g/dL for the HbHemoCueArterial and −1.2 and −4.45±2.05 g/dL for the HbBGA. Inotropic agent administration did not affect the Hb values in all groups.ConclusionsBoth HemoCueCapillary and HemoCueArterial are sufficiently accurate and correlated with automated hematology analyzer in geriatric critically ill patients if used correctly. In terms of Hb levels, arterial and capillary blood sample measurements with HemoCue® provided more clinically acceptable accuracy than blood gas analysis system.

scholarly journals Implementation of HbA1c Point of Care Testing in 3 German Medical Practices: Impact on Workflow and Physician, Staff, and Patient Satisfaction

2018 ◽  
Vol 12 (3) ◽  
pp. 687-694 ◽  
Author(s):  
Karl-Heinz Patzer ◽  
Payam Ardjomand ◽  
Katharina Göhring ◽  
Guido Klempt ◽  
Andreas Patzelt ◽  
...  
Keyword(s):  
Point Of Care ◽  
Venous Blood ◽  
Blood Collection ◽  
Point Of Care Testing ◽  
Practice Physician ◽  
Medical Practices ◽  
Scarce Resources ◽  
Staff Members ◽  
Before And After ◽  
Time Savings

Background: Medical practices face challenges of time and cost pressures with scarce resources. Point-of-care testing (POCT) has the potential to accelerate processes compared to central laboratory testing and can increase satisfaction of physicians, staff members, and patients. The objective of this study was to evaluate the effects of introducing HbA1c POCT in practices specialized in diabetes. Method: Three German practices that manage 400, 550, and 950 diabetes patients per year participated in this evaluation. The workflow and required time before and after POCT implementation (device: Alere Afinion AS100 Analyzer) was evaluated in each practice. Physician (n = 5), staff (n = 9), and patient (n = 298) satisfaction was assessed with questionnaires and interviews. Results: After POCT implementation the number of required visits scheduled was reduced by 80% (88% vs 17.6%, P < .0001), the number of venous blood collections by 75% (91% vs 23%, P < .0001). Of patients, 82% (vs 13% prior to POCT implementation) were able to discuss their HbA1c values with treating physicians immediately during their first visit ( P < .0001). In two of the practices the POCT process resulted in significant time savings of approximately 20 and 22 working days per 1000 patients per year (95% CI 2-46; 95% CI 10-44). All physicians indicated that POCT HbA1c implementation improved the practice workflow and all experienced a relief of burden for the office and the patients. All staff members indicated that they found the POCT measurement easy to perform and experienced a relief of burden. The majority (61.3%) of patients found the capillary blood collection more pleasant and 83% saw an advantage in the immediate availability of HbA1c results. Conclusions: The implementation of HbA1c POCT leads to an improved practice workflow and increases satisfaction of physicians, staff members and patients.

Measurement accuracy of two professional-use systems for point-of-care testing of blood glucose

2020 ◽  
Vol 58 (3) ◽  
pp. 445-455
Author(s):  
Annette Baumstark ◽  
Nina Jendrike ◽  
Ulrike Kamecke ◽  
Christina Liebing ◽  
Stefan Pleus ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Point Of Care ◽  
Venous Blood ◽  
Laboratory Method ◽  
Sample Type ◽  
Point Of Care Testing ◽  
Blood Samples ◽  
Testing Procedures ◽  
Grid Analysis ◽  
Error Grid

AbstractBackgroundThe professional-use systems HemoCue® Glucose 201+ (HC201+) and HemoCue® Glucose 201 RT (HC201RT) are widely used for point-of-care testing (POCT) of blood glucose (BG). HC201RT utilizes unit-use microcuvettes which can be stored at room temperature, whereas HC201+ microcuvettes have to be stored at <8 °C. In this study, system accuracy of HC201+ and HC201RT was evaluated using capillary and venous blood samples.MethodsFor each system, two reagent system lots were evaluated within a period of 2 years based on testing procedures of ISO 15197:2013, a standard applicable for self-monitoring of blood glucose (SMBG) systems. For each reagent system lot, the investigation was performed by using 100 capillary and 95 to 99 venous blood samples. Comparison measurements were performed with a hexokinase laboratory method. Accuracy criteria of ISO 15197:2013 and POCT12-A3 were applied. In addition, bias was analyzed according to Bland and Altman, and error grid analysis was performed.ResultsWhen measuring capillary samples, both systems fulfilled accuracy requirements of ISO 15197:2013 and POCT12-A3 with the investigated reagent system lots. When measuring venous samples, only HC201+ fulfilled these requirements. Bias between HC201+ and reference measurements was more consistent over venous and capillary samples and microcuvette lots than for HC201RT. Error grid analysis showed that clinical actions might have been different depending on which system was used.ConclusionsIn this study, HC201+ showed a high level of accuracy irrespective of the sample type (capillary or venous). In contrast, HC201RT measurement results were markedly affected by the type of sample.

scholarly journals Tools to predict acute traumatic coagulopathy in the pre-hospital setting: a review of the literature

2020 ◽  
Vol 5 (3) ◽  
pp. 23-30
Author(s):  
Simon Robinson ◽  
Jordan Kirton
Keyword(s):  
Major Trauma ◽  
Point Of Care ◽  
Damage Control ◽  
Hospital Setting ◽  
Future Research ◽  
Blood Products ◽  
Point Of Care Testing ◽  
Acute Traumatic Coagulopathy ◽  
Prediction Tools ◽  
Traumatic Coagulopathy

<sec id="s1">Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. </sec> <sec id="s2">Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. </sec> <sec id="s3">Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. </sec> <sec id="s4">Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation. </sec>

scholarly journals A Comparison Study Between Point-of-Care Testing Systems and Central Laboratory for Determining Blood Glucose in Venous Blood

2016 ◽  
Vol 31 (3) ◽  
pp. e22051 ◽  
Author(s):  
Huiping Wei ◽  
Fang Lan ◽  
Qitian He ◽  
Haiwei Li ◽  
Fuyong Zhang ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Point Of Care ◽  
Venous Blood ◽  
Comparison Study ◽  
Central Laboratory ◽  
Point Of Care Testing

Abstract 100: Neuroprotection Provided by Transnasal Airflow-Induced Brain Cooling in a Model of Pediatric Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Zeng-Jin Yang ◽  
C. Danielle Hopkins ◽  
Shawn Adams ◽  
Ewa Kulikowicz ◽  
Harikrishna S Tandri ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Sensorimotor Cortex ◽  
Brain Temperature ◽  
Low Cost ◽  
Venous Blood ◽  
Swine Model ◽  
Brain Cooling ◽  
Surface Cooling ◽  
Arterial Blood ◽  
Normothermic Group

Introduction: High transnasal airflow at ambient temperature increases evaporative cooling of the nasal passages and drives a countercurrent heat exchange between cooled venous blood draining the nasal turbinates with cephalic arterial blood. Hypothesis: High transnasal airflow is not inferior to standard surface cooling in protecting the brain in an infant swine model of asphyxic cardiac arrest. Methods: Arterial O2 saturation was decreased to ~35% for 45 min followed by 7 min airway occlusion to produce asphyxic cardiac arrest in 2-week-old anesthetized piglets (4 kg). Viable neuronal counts were assessed at 6 days of recovery in 6 groups (n=5-9): 1) sham surgery, 2) normothermic recovery, 3) surface cooling to decrease rectal temperature from 38.5 to 34C between 10-120 min 4) transnasal cooling with airflow of 32 L/min from 10-120 min, 5) surface cooling onset delayed until 120 min ROSC, and 6) transnasal cooling delayed by 120 min ROSC. In all 4 cooling groups, hypothermia was sustained at 34C with surface cooling until 20 h ROSC followed by 6-8 h of rewarming. Results: Nasal airflow of 32 L/min decreased brain temperature from 38.3±0.3°C to 33.8±0.6 within 60 min without spatial temperature gradients in these 45-g brains. Surface cooling and transnasal airflow rescued the number of viable neurons in putamen from 38±23% (% of sham viable neurons; ±SD) in the normothermic group to 67±33% and 76±36%, respectively, when initiated at 10 min ROSC, and to 72±30% and 61±25%, respectively, when initiated at 120 min. In sensorimotor cortex, surface cooling and transnasal airflow rescued neurons from 56±36% in the normothermic group to 89±37% and 89±29%, respectively, when initiated at 10 min ROSC, and to 84±19% and 81±28%, respectively, when initiated at 120 min. Conclusions: The use of a high transnasal airflow is as effective as standard surface cooling when initiated at 10 or 120 min after ROSC in protecting vulnerable putamen and sensorimotor cortex from asphyxic cardiac arrest in infant piglets. Because of its simplicity, portability, and low cost, we postulate that transnasal cooling potentially could be deployed in the field by first responders for early initiation of brain cooling prior to maintenance with standard surface cooling after pediatric cardiac arrest.

Accuracy of Point of Care Testing in Patients on Dual Anticoagulation During Initiation of Anticoagulation or Bridging,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3360-3360
Author(s):  
Anja B Drebes ◽  
Paul Priest ◽  
Shaila Bates ◽  
Lida Moghaddam ◽  
Edward GD Tuddenham ◽  
...  
Keyword(s):  
Point Of Care ◽  
Venous Blood ◽  
Plasma Concentrations ◽  
Internal Quality ◽  
Point Of Care Testing ◽  
Blood Samples ◽  
The Mean ◽  
Group 2 ◽  
Therapeutic Doses ◽  
Group 1

Abstract Abstract 3360 Background: Point-of-care testing (POCT) is widely used for monitoring of the international normalized ratio (INR) in patients on oral anticoagulation with a vitamin-K antagonist (VKA) and numerous clinical studies have assessed the accuracy of this method in comparison with INR results from venous blood samples analysed in the laboratory. There is however a paucity of clinical data to support the use of POCT in patients on dual anticoagulation with low molecular weight heparin (LMWH) and a VKA during initiation of anticoagulation or bridging after a surgical procedure. Aim: To test the hypothesis whether therapeutic doses of LMWH interfere with INR measurements when using a POCT system during times of dual anticoagulation with LMWH and a VKA. To further investigate whether the effect is most pronounced once LMWH has reached peak plasma levels and less evident 10 hours and more after administration of LMWH. Methods: We prospectively collected 160 consecutive venous blood samples from patients on therapeutic doses of LMWH - Tinzaparin (175 IU/kg once daily) and a VKA commonly warfarin for INR testing in our laboratory. At the same time all patients had their INR determined on capillary blood collected by finger prick using a CoaguChek XS Pro and INR test strips with the same lot number (Roche Diagnostics Ltd, UK). 60 blood samples were collected within 3–6 hours after administration of LMWH (group 1) and 100 samples were collected 10 hours or more after the last injection of LMWH (group 2). For each sample the dose and time of the last injection of LMWH was recorded along with the time of the venepuncture and the result of the capillary INR. To ensure that we had a wide variation in the plasma concentrations of LMWH we carried out anti-Xa testing on a cross-section of venous samples The dosing advice for Warfarin was based on the INR result of the venous blood sample processed in the laboratory. Results: The correlation coefficient between the POCT INR and the laboratory INR was 0.98 in group 1 and 0.97 in group 2. In the Bland Altman analysis for group 1 the mean 95% confidence interval (CI) was 0.03 (range+/− 1.96 SD: −0.26 to +0.32) and for group 2 the mean 95% CI was 0.00 (range −0.28 to +0.29). These results are comparable to results of our internal quality control between POCT INR and laboratory INR in patients on VKA alone with a mean 95% CI of −0.02 (range −0.26 to +0.29). The mean INR was 1.8 by both methods in group 1 and 1.7 by both methods in group 2 and anti-Xa levels ranged from 0 to1.19 U/mL. A variation in the result of the POCT INR and laboratory INR of 0.5 or greater is thought to affect dosing decisions for Warfarin. Such a variation was observed in 3% (2/60) in group 1 and 2% (2/100) in group 2. Conclusion: There was good accuracy of the INR obtained with the POCT system used and this was not affected by the timing of the administration of LMWH in relation to testing. Disclosures: No relevant conflicts of interest to declare.

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