How often do central venous access attempts succeed in patients treated by air medical crews?

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Vascular access is vital when resuscitating critically ill or injured patients, both for giving fluids and delivering medications. However, peripheral access is not always possible in patients with hypovolemia or difficult anatomy. Central venous access offers air medical crews an alternative, with relatively predictable anatomy even in unstable patients. When deciding whether to attempt it, crews need to consider the procedure’s success and complication rates in the hands of flight air medical personnel.

The study aimed to explore success and complication rates for central venous access attempts in patients treated by air medical crews. This was a retrospective review using advanced procedure quality improvement forms. It included all air medical patients in whom central venous access was attempted over a 30-month period. Femoral and subclavian lines were compared for how often they were attempted, success rates, and complications.

The review identified 50 patients over the 30-month study period. Femoral and subclavian attempts occurred approximately equally often. The overall success rate was 66%: 60% for subclavian access, 67% for femoral access, and 73% for access at a nonspecified site. The mean number of attempts was 1.2 for each approach. The only reported complication was placement in an artery during a subclavian attempt.

The researchers concluded that air medical central venous access attempts had moderate success rates and a low incidence of reported complications.