Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study

Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study Samuel Galvagno, James Cloepin, Jeannie Hannas, Kurt Rubach, Andrew Naumann, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-380767/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version 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 pragmatic, randomized, controlled, crossover study comparing two different 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 minutes, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and multiple linear regression 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, fewer mid-infusion adjustments, and greater ease of use. Conclusions Use of a metronome technique for establishing medication infusion rates may help prehospital clinicians provide safer and more precise medication delivery. Critical Care & Emergency Medicine prehospital emergency medical services medication infusion medical calculation medication dosing resuscitation Figures Figure 1 Figure 2 Figure 3 Full Text Additional Declarations Competing interest reported. 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. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 11 May, 2021 Reviews received at journal 07 May, 2021 Reviewers agreed at journal 27 Apr, 2021 Reviewers invited by journal 27 Apr, 2021 Editor assigned by journal 27 Apr, 2021 Editor invited by journal 27 Apr, 2021 Submission checks completed at journal 27 Apr, 2021 First submitted to journal 31 Mar, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-380767","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":23585065,"identity":"b14fdab1-700d-4033-89fe-76f5ea004e06","order_by":0,"name":"Samuel Galvagno","email":"data:image/png;base64,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","orcid":"","institution":"University of Maryland, Baltimore","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Galvagno","suffix":""},{"id":23585066,"identity":"ae9bb653-52a4-4707-8dd7-4af74cdf5a65","order_by":1,"name":"James Cloepin","email":"","orcid":"","institution":"Anne Arundel Fire Department","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Cloepin","suffix":""},{"id":23585067,"identity":"a3ae54d6-7ef7-45cc-836c-1cf67ababc38","order_by":2,"name":"Jeannie Hannas","email":"","orcid":"","institution":"Anne Arundel Fire Department","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jeannie","middleName":"","lastName":"Hannas","suffix":""},{"id":23585068,"identity":"f1889915-0a09-4c2c-8916-3d1d5dd33cbe","order_by":3,"name":"Kurt Rubach","email":"","orcid":"","institution":"University of Maryland Baltimore Washington Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kurt","middleName":"","lastName":"Rubach","suffix":""},{"id":23585069,"identity":"fae18911-a3d5-416d-8f2d-4400e385fb62","order_by":4,"name":"Andrew Naumann","email":"","orcid":"","institution":"Maryland Institute of Emergency Medical Services Systems","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Naumann","suffix":""},{"id":23585070,"identity":"5ea173cc-8ac0-4804-9194-b95e16a9214d","order_by":5,"name":"Jonathan Wendell","email":"","orcid":"","institution":"University of Maryland Baltimore Washington Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jonathan","middleName":"","lastName":"Wendell","suffix":""}],"badges":[],"createdAt":"2021-03-31 19:29:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-380767/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-380767/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":8562830,"identity":"d2c78383-7014-4cee-8f28-ed0e8661494c","added_by":"auto","created_at":"2021-04-28 18:42:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":274768,"visible":true,"origin":"","legend":"CONSORT study flow diagram. 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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. \n\nThe remaining authors have no competing interests to disclose.","formattedTitle":"\u003cp\u003eComparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"This preprint is available for \u003ca href='/article/rs-380767/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e."}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"prehospital, emergency medical services, medication infusion, medical calculation, medication dosing, resuscitation","lastPublishedDoi":"10.21203/rs.3.rs-380767/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-380767/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eLimited 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 pragmatic, randomized, controlled, crossover study comparing two different 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. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003e\u003c/p\u003e\u003cp\u003eForty-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 minutes, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia.\u0026nbsp;Descriptive statistics and multiple linear regression were used for data analysis. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWhen compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal, fewer mid-infusion adjustments, and greater ease of use. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003e\u003c/p\u003e\u003cp\u003eUse of a metronome technique for establishing medication infusion rates may help prehospital clinicians provide safer and more precise medication delivery.\u003c/p\u003e","manuscriptTitle":"Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-04-28 18:42:00","doi":"10.21203/rs.3.rs-380767/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-05-11T19:07:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-05-07T07:00:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5add14a2-e4e3-429e-bb3a-d6a3d402a2b9","date":"2021-04-27T18:43:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-04-27T17:14:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-04-27T12:29:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-04-27T12:24:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-04-27T12:05:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2021-03-31T19:16:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"670f29ae-aaf9-45ae-aa34-c6eda15082f0","owner":[],"postedDate":"April 28th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":3961345,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2021-09-01T02:59:04+00:00","versionOfRecord":[],"versionCreatedAt":"2021-04-28 18:42:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-380767","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-380767","identity":"rs-380767","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}