Safety of pre‐hospital peripheral vasopressors: The SPOTLESS study (Safety of PrehOspiTaL pEripheral vaSopreSsors)

Objective To assess the safety and effectiveness of peripheral vasoactive drugs initiated during pre‐hospital care and retrieval missions, in Queensland, Australia. Methods Three years of retrospective data was gathered from two sources. Medical notes were reviewed using a search for any patient having ‘inotrope’ recorded on an electronic medical record. Each case was reviewed to include only peripheral infusions of adrenaline or noradrenaline. Clinical Governance records were searched for adverse events related to vasoactive drugs, alerted for review to ensure complete capture. Results A total of 418 patients received peripheral infusions of adrenaline and noradrenaline over the 3‐year period. No major complications were recorded either immediately or at Clinical Governance review. Minor complications were recorded in 4.7% of the cases, of which 3.5% occurred with peripheral vasoactives during the presence of the retrieval team. The frequency of use of peripheral vasoactives increased over the study period. Conclusions In this retrospective data set there were no major complications of peripheral vasoactive drugs. Minor complications were similar to in‐hospital use and related to vascular access and drug delivery. The largest trial to date examining the safety of peripheral vasopressors in the pre‐hospital and retrieval environment. We found an expanding use of peripheral vasopressors and a safety profile very similar to that found in patients in the ED or ICU.