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  5. Clinical Utility of the epoc Blood Analysis System in the Pre-hospital Setting

Clinical Utility of the epoc Blood Analysis System in the Pre-hospital Setting

2021 EMS World Innovation awards winner ribbon

Pre-hospital personnel, including emergency medical services (EMS) first responders, EMTs, and paramedics, are trained to assess patient signs and symptoms and deliver specific protocol-based treatments in the field, serving a critical role in improving the outcomes of both acute diseases and acute exacerbations of chronic illnesses.1

The availability of point-of-care-testing in the pre-hospital setting can supplement the expert clinical assessment provided by these healthcare professionals and potentially improve diagnostic accuracy, leading to rapid initiation of appropriate therapeutic actions.

    A University of Alabama at Birmingham study demonstrated implementation of POCT in critical care transport led to a change in treatment, or therapeutic yield, of 30% in patients with a wide variety of diagnoses, including trauma, cardiac, pulmonary, and transplant conditions and premature birth.3

    Point-of-care blood analysis systems that provide on-the-scene measurements, including metabolites, electrolytes and blood gases, have been demonstrated to be valuable tools in improving patient outcomes.3 These tests can provide a snapshot of a patient’s health, indicating problems such as:4

    • Kidney failure
    • Insulin shock or diabetic coma
    • Respiratory distress
    • Heart rhythm changes

    Some potential scenarios for use of POCT in the pre-hospital setting include:5

    • Identification of hyperkalemia (high potassium) as the cause of EKG changes that could precede a cardiac arrest
    • Identification of septic shock by an elevated lactate level in the presence of a known infection
    • Measurement of creatinine to identify acute kidney injury (AKI)
    • Blood gas testing to distinguish respiratory distress from respiratory failure, determine who should receive CPAP or intubation, and monitor/adjust ventilator settings

    Table 1: Indications for the use of pre-hospital blood analysis in emergency situations.6-8

    Indication

    Test

    1

    All forms of dyspnea or hypoxia

    Blood gases

    2

    Cardiopulmonary resuscitation

    Blood gases and electrolytes

    3

    Suspected acidosis

    Blood gases and electrolytes

    4

    Cardiogenic shock resistant to therapy

    Blood gases and electrolytes

    5

    Control of mechanical ventilation

    Blood gases

    6

    Cardiac arrhythmias and tachycardia

    Electrolytes

    7

    Tissue hypoxia, sepsis, septic shock, and hypovolemic shock

    Lactate

    8

    Diabetes, altered mental state, seizure, acute coronary syndrome, organ injury, trauma, sepsis, septic shock, and burns

    Glucose

    9

    Internal or external hemorrhage; estimation of blood loss

    Hemoglobin and hematocrit

    10

    Hydration status

    Electrolytes

    11

    Kidney function prior to administration of contrast agents in CT or MRI

    Creatinine

    Table 2: Key measurements from point-of-care blood analysis: a snapshot of patient health.8-10

    Metabolites & Electrolytes

    This collection of tests―sometimes referred to as basic chemistries or a basic metabolic panel―provides a snapshot into a patient’s health, including kidney function, blood sugar levels, and levels of key ions involved in fluid balance. These measurements include:8

    Metabolites

    • Blood Urea Nitrogen (BUN)
    • Creatinine (Cr)
    • Glucose
    • Lactate

    Electrolytes

    • Sodium (Na+)
    • Potassium (K+)
    • Chloride (Cl-)
    • Ionized Calcium (Ca++)
    • Anion Gap

    Blood Gas

    Blood gas analysis provides several important measurements, which together provide insight into a patient’s pulmonary gas exchange, blood oxygenation, and acid-base balance.9 These measurements can be affected in a range of respiratory and non-respiratory diseases.

    • pH - Hydrogen ion (H+)
    • Carbon Dioxide Partial Pressure (pCO2)
    • Bicarbonate (HC03-)
    • Base Excess (BE)
    • Oxygen partial pressure (pO2)
    • Oxygen Saturation (sO2)
    • Hemoglobin (Hb)
    epoc Blood Analysis System

    The epoc Blood Analysis System: a valuable tool in pre-hospital care

    The epoc Blood Analysis System enables fast, accurate, and easy measurement of metabolites, electrolytes, and blood gas from only a few drops of blood (see Table 3).9

    • Room-temperature stability
    • Arterial, venous or capillary samples
    • Results available in < 1 minute

    Published reports demonstrate that emergency medical services that have implemented the epoc system have experienced the value of adding point-of-care diagnostic testing to their pre-hospital care.11,12

    • A North Carolina hospital-associated critical care transport team implemented the epoc Blood Analysis system as a way to begin sepsis treatment in the field.11 Using the epoc system to obtain a lactate level in the field helped them achieve their goal: In the first year, they reduced mortality from 47% to 24%, eventually decreasing to 14%. Additionally, they reported:

      “We’ve found that nearly half the time someone runs labs in one of our vehicles, they can directly link that to a change in the care provided to that patient.”
    • A Texas EMS agency reported using the epoc system on approximately 50% of their calls, referring to the lab results it provides as “a game changer” and reporting that the response from receiving facilities was quite positive:12

      “I’ll tell you, nothing makes the receiving emergency department staff (nurses and physicians) happier than when you walk in the door with labs in hands. They’re even happier when you walk in with initial labs in hand, explain your treatment plan, and follow-up labs showing improvement and/or complete resolution of the issue. It alleviates a lot of the workload, as the nursing staff isn’t scrambling to draw labs, and allows the staff to focus on a proper transfer of patient care.”12

    Table 3: epoc Blood Analysis System Critical Testing Parameters

    pH, pCO2, pO2 (blood gases)

    Aid in the diagnosis and aid in the treatment of life-threatening acid-base disturbances

    Total Carbon Dioxide (TCo2)

    Aid in the diagnosis and aid in the treatment of disorders associated with changes in body acid-base balance

    Sodium (Na+)

    Aid in the diagnosis and aid in the treatment of diseases involving electrolyte imbalance

    Potassium (K+)

    Aid in the diagnosis and aid in the treatment of diseases involving electrolyte imbalance

    Calcium (Ca+)

    Aid in the diagnosis and aid in the treatment of parathyroid disease, a variety of bone diseases, chronic renal disease, and tetany

    Chloride (Cl-)

    Aid in the diagnosis and aid in the treatment of electrolyte and metabolic disorders.

    Glucose (BGL)

    Aid in the diagnosis and aid in the treatment of carbohydrate metabolism disorders, including diabetes mellitus and idiopathic hypoglycemia, and of pancreatic islet cell tumors

    Lactate

    Evaluation of acid base status and are used in the diagnosis and treatment of lactic acidosis (abnormally high acidity of the blood)

    Blood Urea Nitrogen (BUN)

    Aid in the diagnosis and aid in the treatment of certain renal and metabolic diseases

    Creatinine (Cr)

    Aid in the diagnosis and aid in the treatment of certain renal diseases and monitoring of renal dialysis

    Hematocrit

    Distinguishing normal from abnormal states of blood volume, such as anemia and erythrocytosis

    Calculated Values

    • Bicarbonate cHCO3-
    • Calculated Total Carbon Dioxide cTCO2
    • Base Excess BE
    • Oxygen Saturation cSO2
    • Alveolar Oxygen A
    • Arterial Alveolar Oxygen Tension Gradient A-a
    • Arterial Alveolar Oxygen Tension Ratio a/A
    • Anion Gap AGap
    • AGapK
    • Estimated Glomerular Filtration Rate
      • GFRmgr
      • GFRmdr-a
      • GFRckd
      • GFRckd-a
      • GFRswz
    • BUN/Crea Ratio
    • Urea/Crea Ratio
    • Hemoglobin cHgb
    1

    https://intjem.biomedcentral.com/articles/10.1186/s12245-018-0207-6. Accessed 7-1-21.

    2

    https://smhs.gwu.edu/urgentmatters/news/pre-hospital-point-care-testing-increasing-value-ems-care. Accessed 7-1-21.

    3

    Gruszecki AC. Utilization, reliability, and clinical impact of point-of-care testing during critical care transport: six years of experience. Clinical Chemistry 49, No. 6, 2003.

    4

    https://www.hmpgloballearningnetwork.com/site/emsworld/article/11289724/whats-point-point-care-testing. Accessed 7-1-21.

    5

    https://www.jems.com/patient-care/acid-base-balance-understanding-is-critical-to-treat-patients. Accessed 7-1-21.

    6

    Prause, G et al. “Prehospital point of care testing of blood gases and electrolytes―an evaluation of IRMA.” Critical Care (London, England) vol. 1,2 (1997): 79-83. doi:10.1186/cc108.

    7

    https://acutecaretesting.org/en/articles/poc-testing-in-the-emergency-department-strategies-to-improve-clinical-and-operational-outcomes. Accessed 7-1-21.

    8

    https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=basic_metabolic_panel_blood. Accessed 7-1-21.

    9

    epoc System Manual with epoc NXS Host. 51015952 Rev.:02 siemens.com/eIFU. 2021-05.

    10

    Mikulcik P. Rapid analysis―Blood gases and more. Siemens Healthcare Diagnostics GmbH – Eschborn, 2008 Dec.

    11

    https://www.jems.com/administration-and-leadership/one-step-ahead-2. Accessed 7-1-21. 

    12

    http://txemsa.com/blood-labs-qa-with-ben-oakley-and-jonathan-sell. Accessed 7-1-21.

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