Abstract：
UNASSIGNED: The prehospital treatment for stable patients with atrial fibrillation with rapid ventricular response is rate-controlling agents such as calcium channel blockers, often diltiazem given as a bolus. At our agency we encourage the use of a bolus given via the infusion pump over two to four minutes immediately followed by a maintenance infusion, given concerns of recurrent tachycardia or hypotension secondary to rapid bolus administration. We examined if administering a bolus and infusion via an infusion pump shows better heart rate (HR) control at arrival to the emergency department (ED) compared with administration of a bolus only, while maintaining hemodynamic stability during transport. We also analyzed if a patient received a second bolus within 60 min of arrival to the ED.
UNASSIGNED: We used a retrospective propensity-matched cohort of prehospital patients with atrial fibrillation for whom diltiazem was administered, from 1/1/2018 to 12/31/2021, in our system of 10 New Jersey paramedic units. We analyzed the age, gender, and initial HR and used it to match groups. We analyzed the mode and time of administration, dosage of the bolus, and presence of hypotension prehospitally.
UNASSIGNED: The matched groups contained 145 patients who received a prehospital diltiazem bolus only (BO) and 146 patients who received a diltiazem bolus and infusion (BI). There was no significant difference between the mean change in HR from initial paramedic arrival to ED arrival between the two groups (BO 38 vs. BI 34, p = 0.16). There was no significant difference in the need for a second bolus within the first 60 min of arrival to the ED (BO 9.7% vs. BI 11.6%, p = 0.30). Patients in the BO group were more likely to experience prehospital hypotension then in the BI group (BO 17.2% vs BI 8.2%, p = 0.01), despite receiving smaller initial bolus doses (BO 14.2 mg vs. BI 17.4 mg, p < 0.001).
UNASSIGNED: Our results show no significant differences in HR control or need for repeat bolus at the ED with the use of a diltiazem infusion following a diltiazem bolus. However, even when administering larger boluses, the use of an infusion pump resulted in less hypotension.
UNASSIGNED: We used a retrospective propensity-matched cohort of prehospital patients with atrial fibrillation for whom diltiazem was administered, from 1/1/2018 to 12/31/2021, in our system of 10 New Jersey paramedic units. We analyzed the age, gender, and initial HR and used it to match groups. We analyzed the mode and time of administration, dosage of the bolus, and presence of hypotension prehospitally.
UNASSIGNED: The matched groups contained 145 patients who received a prehospital diltiazem bolus only (BO) and 146 patients who received a diltiazem bolus and infusion (BI). There was no significant difference between the mean change in HR from initial paramedic arrival to ED arrival between the two groups (BO 38 vs. BI 34, p = 0.16). There was no significant difference in the need for a second bolus within the first 60 min of arrival to the ED (BO 9.7% vs. BI 11.6%, p = 0.30). Patients in the BO group were more likely to experience prehospital hypotension then in the BI group (BO 17.2% vs BI 8.2%, p = 0.01), despite receiving smaller initial bolus doses (BO 14.2 mg vs. BI 17.4 mg, p < 0.001).
UNASSIGNED: Our results show no significant differences in HR control or need for repeat bolus at the ED with the use of a diltiazem infusion following a diltiazem bolus. However, even when administering larger boluses, the use of an infusion pump resulted in less hypotension.
摘要：
目的:对伴有快速心室反应的稳定期房颤患者的院前治疗是钙通道阻滞剂等控速剂,通常地尔硫卓作为丸剂给予。在我们的机构，我们鼓励通过输液泵在两到四分钟内使用推注，然后立即进行维持输注，考虑到快速推注给药继发的复发性心动过速或低血压。我们检查了与仅进行推注相比，通过输液泵进行推注和输注在到达急诊科（ED）时是否显示出更好的心率（HR）控制。在运输过程中保持血液动力学稳定性。我们还分析了患者是否在到达ED后60分钟内接受了第二次推注。方法：我们使用了一项回顾性倾向匹配队列，对接受地尔硫卓治疗的院前房颤患者进行了研究，从2018年1月1日至2021年12月31日，在我们的10个新泽西州护理人员单位系统中。我们分析了年龄,性别,和初始HR并用它来匹配组。我们分析了管理的模式和时间，丸剂的剂量，和住院前低血压的存在。结果：匹配组包含145例仅接受院前地尔硫卓推注（BO）的患者和146例接受地尔硫卓推注和输注（BI）的患者。两组之间从最初的护理人员到达到ED到达的平均HR变化之间没有显着差异（BO38与BI34，p=0.16)。在到达ED的前60分钟内，第二次推注的需求没有显着差异（BO9.7％与BI11.6%，p=0.30)。BO组患者比BI组患者更有可能出现院前低血压（BO17.2%vsBI8.2%，p=0.01),尽管接受较小的初始推注剂量（BO14.2mgvs.BI17.4毫克，p<0.001)。结论：我们的结果表明，在进行地尔硫卓推注后使用地尔硫卓输注时，HR控制或需要在ED重复推注没有显着差异。然而,即使在施用更大的丸剂时，使用输液泵减少了低血压.
