Stability of Drugs Stored in Helicopters for Use by Emergency Medical Services: A Prospective Observational Study - 21/09/22
, Johannes Moeckel, MD d, Joachim Koppenberg, MD c, e, Dario Josi, PhD f, g, Arne Jungwirth, PhD h, Wolf E. Hautz, MD b, Volker Wenzel, MD i, Stephan Strecke j, Roland Albrecht, MD a, b, cAbstract |
Study objective |
Drugs stored in rescue helicopters may be subject to extreme environmental conditions. The aim of this study was to measure whether drugs stored under the real-life conditions of a Swiss helicopter emergency medical service (HEMS) would retain their potency over the course of 1 year.
Methods |
A prospective, longitudinal study measuring the temperature exposure and concentration of drugs stored on 2 rescue helicopters in Switzerland over 1 year. The study drugs included epinephrine, norepinephrine, amiodarone, midazolam, fentanyl, naloxone, rocuronium, etomidate, and ketamine. Temperatures were measured inside the medication storage bags and the crew cabins at 10-minute intervals. Drug stability was measured on a monthly basis over the course of 12 months using high-performance liquid chromatography. The medications were considered stable at a minimum remaining drug concentration of 90% of the label claim.
Results |
Temperatures ranged from −1.2 °C to 38.1 °C (29.84 °F to 100.58 °F) inside the drug storage bags. Of all the temperature measurements inside the drug storage bags, 37% lay outside the recommended storage conditions. All drugs maintained a concentration above 90% of the label claim. The observation periods for rocuronium and etomidate were shortened to 7 months because of a supply shortage of reference samples.
Conclusion |
Drugs stored under the real-life conditions of Swiss HEMS are subjected to temperatures outside the manufacturer’s approved storage requirements. Despite this, all drugs stored under these conditions remained stable throughout our study. Real-life stability testing could be a way to extend drug exchange intervals.
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| Please see page 365 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Lewis S. Nelson, MD. Specific detailed information about possible conflicts of interest for individual editors is available at editors. |
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| Author contributions: UP, RA, and JM conceived the study and designed the trial. JM and SS conducted the study and collected data. SS performed the laboratory analyses. DJ and AJ provided statistical advice on study design. UP, JM, JK, VW, WEH, AJ, and DJ analyzed the data. JM drafted the article, and all authors contributed substantially to its revision. UP takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria:(1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Fundingandsupport: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support. |
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Vol 80 - N° 4
P. 364-370 - octobre 2022 Retour au numéro
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