Are arterial lines recommended in the Emergency Department (ED)?

From the Guidelines

Arterial lines are recommended in the Emergency Department (ED) for specific patient populations, such as those undergoing emergency laparotomy or donation after circulatory death organ procurement, as they provide accurate continuous blood pressure readings and allow for precise determination of hemodynamic thresholds 1.

Key Benefits of Arterial Lines

• Allow for accurate continuous reading of blood pressure throughout the withdrawal process or surgery
• Enable procurement teams to accurately determine the precise time points when specific hemodynamic thresholds are reached
• Provide useful real-time blood pressure measurement and allow frequent arterial blood gas sampling to guide therapy 1

Recommendations for Use

• Should be routinely placed prior to withdrawal of life-sustaining treatment (WLST) to accurately determine loss of circulation and duration of functional death 1
• Should be considered at an early stage to aid in physiological assessment and to deliver and titrate vasopressors and fluid therapy in emergency laparotomy patients 1

Important Considerations

• The use of arterial lines should be individualized to the patient and their specific needs
• The decision to use an arterial line should be based on the patient's underlying condition, the complexity of the procedure, and the potential benefits and risks of the intervention 1

From the Research

Arterial Lines in the Emergency Department

• The use of arterial lines in the Emergency Department (ED) is a common practice, with studies suggesting its feasibility and potential benefits in patient care 2, 3.
• A study published in 2011 found that arterial line placement was successful in 83.9% of patients in a prehospital setting, with a median time of 2 minutes for successful cannulation 2.
• Another study published in 2023 reviewed the controversies and evidence surrounding arterial line insertion in the ED, highlighting the variation in clinician preference and technique 3.
• The use of ultrasound-guided arterial line placement has been shown to be more effective and efficient than traditional palpation methods, with shorter placement times and fewer attempts required 4.

Indications and Therapeutic Consequences

• The main indications for arterial line placement include cardiopulmonary resuscitation, post-resuscitation care, respiratory insufficiency, and unconsciousness 2.
• The therapeutic consequences of arterial line placement depend on the availability of blood gas analysis and can lead to important changes in patient management, such as fluid, vasoactive, or antihypertensive therapy 2, 5.
• A systematic literature review and survey of UK helicopter emergency medical services found that while there is limited evidence on the benefits of arterial lines and blood gases in the prehospital setting, clinicians believe it can allow for better monitoring and more targeted treatment 5.

Safety and Management

• The management of arterial lines and blood sampling in intensive care units has been identified as a potential threat to patient safety, with variability in practice and non-adherence to recommended guidelines 6.
• A survey of UK intensive care units found that while some recommendations for safe arterial line management had been widely implemented, others had not, and there was a significant risk of using the wrong fluid as an arterial flush 6.