Utilization, Reliability, and Clinical Impact of Point-of-Care Testing during Critical Care Transport: Six Years of Experience

The use of point-of-care testing (POCT) has been reported in the setting of critical care transport (1)(2)(3)(4)(5)(6), although the overall benefits have not been evaluated in depth. In addition, problems with testing reliability may be uncovered only after an extended period of field use. This report describes the use of POCT by our critical care transport program over 6 years. All critical care transports made from January 1996 to December 2001 were reviewed. Transport vehicles were ambulances or twin-engine jets. The transport teams consisted of a physician on transport or with radio contact, a respiratory therapist, and a registered nurse. All transports were equipped with i-STAT® portable analyzers (i-STAT® Corporation) and disposable cartridges for testing. The analyzer and cartridges were stored in an insulated bag for temperature control during the trip. The analytical performance verification protocol (electronic controls) recommended in the i-STAT System Manual was followed before each patient test. Liquid controls were run monthly. Proficiency testing was completed in accordance with the requirements of the College of American Pathologists. The manufacturer’s test cartridges were the G3, 6+, EG7+, and glucose. Tests included pH, P co2, P o2, calculated bicarbonate, total CO2, base excess, oxygen saturation, sodium, potassium, chloride, urea, glucose, hematocrit, and calculated hemoglobin and glucose. Each cartridge requires 65 μL of whole blood for testing. The blood was drawn and analyzed by physician order. From 1997 through 2001, the team filled out an evaluation form for quality review after cases where POCT was performed. Patient test results and charts for each POCT episode were reviewed retrospectively to identify changes in treatment linked to test results. Other data were extracted from transport department and quality-control records. This research was approved by …