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Randomized Controlled Trial
. 2021 Oct 7;21(1):111.
doi: 10.1186/s12873-021-00503-6.

Comparison of a metronome-guided prehospital medication infusion technique with standard calculation: a simulated randomized, controlled, cross-over study

Samuel M Galvagno  1   2 , James Cloepin  3 , Jeannie Hannas  3 , Kurt S Rubach  4 , Andrew Naumann  5 , Jonathan Wendell  3   6
Affiliations
Randomized Controlled Trial

Comparison of a metronome-guided prehospital medication infusion technique with standard calculation: a simulated randomized, controlled, cross-over study

Samuel M Galvagno et al. BMC Emerg Med. .

Abstract

Background: Limited research regarding administration of timed medication infusions in the prehospital environment has identified wide variability with accuracy, timing, and overall feasibility. This study was a quality improvement project that utilized a randomized, controlled, crossover study design to compare two different educational techniques for medication infusion administration. We hypothesized that the use of a metronome-based technique would decrease medication dosage errors and reduce time to administration for intravenous medication infusions.

Methods: Forty-two nationally registered paramedics were randomized to either a metronome-based technique versus a standard stopwatch-based technique. Each subject served as a control. Subjects were asked to establish an infusion of amiodarone at a dose of 150 mg administered over 10 min, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and a repeated measures mixed linear regression model were used for data analysis.

Results: When compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal (median 34 s [IQR, 22-54] vs 50 s; [IQR 38-61 s], P = 0.006) and fewer mid-infusion adjustments. Ease of use was reported to be significantly higher for the metronome group (median ranking 5, IQR 4-5) compared to the standard group (median ranking 2, IQR 2-3; P < 0.001).

Conclusions: Knowledge regarding a metronome technique may help EMS clinicians provide safe and effective IV infusions. Such a technique may be beneficial for learners and educators alike.

Keywords: Emergency medical services; Medical calculation; Medication dosing; Medication infusion; Prehospital; Resuscitation.

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Conflict of interest statement

Dr. Galvagno reports personal fees from Northwest Anesthesia Seminars, grants from the Department of Defense, and is an employee of the United States Air Force Reserve. However, nothing in this work is related to this employment. The views expressed are those of the author and do not reflect the views of the US Air Force, the Department of Defense, or US Government.

The remaining authors have no competing interests to disclose.

Figures

Fig. 1
Fig. 1
CONSORT study flow diagram
Fig. 2
Fig. 2
Box and whisker plots depicting median time to infusion rate goal. P = 0.006
Fig. 3
Fig. 3
Self-reported ease of use
See this image and copyright information in PMC

References

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