The Emergency Department Crash Cart: A systematic review and suggested contents

doi:10.5847/wjem.j.1920-8642.2018.02.002

Abstract

Abstract:

BACKGROUND: As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specifically discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients.
METHODS: The authors performed a systematic review of EDCC-specific literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council (ERC) guidelines for resuscitation, and the 2013 American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS) 9th edition.
RESULTS: There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the final four articles specific to EDCC, and proposes a set of suggested contents for the EDCC.
CONCLUSION: Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.

Key words: Resuscitation, Crash cart, Emergency department

Gabrielle A. Jacquet, Bachar Hamade, Karim A. Diab, Rasha Sawaya, Gilbert Abou Dagher, Eveline Hitti, Jamil D. Bayram. The Emergency Department Crash Cart: A systematic review and suggested contents[J]. World Journal of Emergency Medicine, 2018, 9(2): 93-98.

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Table 1

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References 32

1	United States Government Accountability Office. Hospital Emergency Departments: Crowding Continues to Occur, and Some Patients Wait Longer than Recommended Time Frames. 2009.
2	Middleton KR, Burt CW. Availability of pediatric services and equipment in emergency departments: United States, 2002-03. Advance data from vital and health statistics; no 367. Hyattsville, Maryland: National Center for Health Statistics. 2006.
3	Simpson KH. Advanced Life Support, 5th Ed. Vol 97(2). London, UK: The Resuscitation Council; BJA 2006. doi: 10.1093/bja/aep135 pmid: 19460775
4	Shultz J, Davies JM, Caird J, Chisholm S, Ruggles K, Puls R. Standardizing anesthesia medication drawers using human factors and quality assurance methods. J Can Anesth 2010;57(5):490-9. doi: 10.1007/s12630-010-9274-8
5	Rousek JB, Hallbeck MS. Improving medication management through the redesign of the hospital code cart medication drawer. Hum Factors. 2011;53(6):626-36. doi: 10.1177/0018720811426427
6	Kienle PC. JCAHO Med Management: Meeting the Standards for Emergency Medications and Labeling. Hosp Pharm 2006;41:888. doi: 10.1310/hpj4109-888
7	Agarwal S, Swanson S, Murphy A, Yaeger K, Sharek P, Halamek LP. Comparing the utility of a standard pediatric resuscitation cart with a pediatric resuscitation cart based on the Broselow tape: a randomized, controlled, crossover trial involving simulated resuscitation scenarios. Pediatrics. 2005;116(3):e326-333. doi: 10.1542/peds.2005-0320 pmid: 16061568
8	Begg JE. A pediatric care and resuscitation cart: one community hospital’s ED experience. J Emerg Nurs. 1995;21(6):555-9. doi: 10.1016/s0099-1767(05)80278-8 pmid: 8709471
9	Chan J, Chan B, Ho HL, Chan KM, Kan PG, Lam HS. The neonatal resuscitation algorithm organized cart is more efficient than the airway-breathing-circulation organized drawer: a crossover randomized control trial. Eur J Emerg Med. 2016;23(4):258-62. doi: 10.1097/MEJ.0000000000000251 pmid: 25710083
10	Green DA, Chowdhary S, Tiwari L, Lata S. Development of an indigenous pediatric crash cart based on the ABC of resuscitation. Trop Doct. 2006;36(4):216-7. doi: 10.1258/004947506778604751 pmid: 17034694
11	Maul E, Latham B, Westgate PM. Saving time under pressure: effectiveness of standardizing pediatric resuscitation carts. Hosp Pediatr. 2016 ;6(2):67-71. doi: 10.1542/hpeds.2015-0161 pmid: 26794403
12	Cohen ML. Is your code cart ready? Med Econ. 2005;82(18):45-6, 48. pmid: 16300216
13	Hand H, Banks A. The contents of the resuscitation trolley. Nurs Stand. 2004;18(44):43-52. doi: 10.7748/ns2004.07.18.44.43.c3647 pmid: 15317254
14	Nussbaum G, Fisher JG. A crash cart that works. Am J Nurs. 1978;78(1):45-8. pmid: 245245
15	Telesca KA. Simplistic approach to restocking crash carts. Hosp Pharm. 1992 ;27(12):1068-70, 1072. pmid: 10122510
16	Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S315-67. doi: 10.1161/CIR.0000000000000252 pmid: 26472989
17	Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015;95:1-80. doi: 10.1016/j.resuscitation.2015.07.038 pmid: 26477410
18	ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International ATLS working group. Advanced trauma life support (ATLS^®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363-6. doi: 10.1097/TA.0b013e31828b82f5 pmid: 23609291
19	de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S526-42. doi: 10.1161/CIR.0000000000000266 pmid: 26473000
20	Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S543-60. doi: 10.1161/CIR.0000000000000267 pmid: 26473001
21	Hall MH. A resuscitation trolley for the emergency and accident department. Injury. 1972;3(3):203-4. doi: 10.1016/0020-1383(72)90084-8 pmid: 5058942
22	Haworth FB. Accident and emergency resuscitation trolley. Nurs Times. 1974;70(19):707. pmid: 4840609
23	Meyer D, Ritter M. The “Tox Box”: a mobile resuscitation cart for toxicologic emergencies. J Emerg Nurs. 1994;20(4):335-337. pmid: 8057603
24	niversity of Illinois at Chicago College of Pharmacy, Drug Information Group. Light-sensitive injectable prescription drugs. Hosp Pharm. 2014;49(2):136-163. doi: 10.1310/hpj4902-136 pmid: 24623868
25	Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64. doi: 10.1161/CIR.0000000000000261 pmid: 26472995
26	Periyanayagam U, Dreifuss B, Hammerstedt H, Chamberlaince S, Nelsoncf S, Jon K, et al. Acute care needs in a rural Sub-Saharan African Emergency Centre: A retrospective analysis. Afr J Emerg Med. 2012;2(4):151-158. doi: 10.1016/j.afjem.2012.09.002
27	Little RM, Kelso MD, Shofer FS, Arasaratnamd MH, Wentworthe S, Martindf IBK, et al. Acute care in Tanzania: Epidemiology of acute care in a small community medical centre. Afr J Emerg Med. 2013;3(4):`64-7. doi: 10.1016/j.afjem.2020.06.005 pmid: 32837876
28	Clark EG, Watson J, Leemann A, Breaud AH, Feeley FG, Wolff J, et al. Acute care needs in an Indian emergency department: A retrospective analysis. World J Emerg Med. 2016;7(3):191-5. doi: 10.5847/wjem.j.1920-8642.2016.03.005 pmid: 27547278
29	Dünser MW, Festic E, Dondorp A, Kissoon N, Ganbat T, Kwizera A, et al. Recommendations for sepsis management in resource-limited settings. Intensive Care Med. 2012;38(4):557-74. doi: 10.1007/s00134-012-2468-5 pmid: 22349419
30	Jacob ST, Lim M, Banura P, Bhagwanjee S, Bion J, Cheng AC, et al. Integrating sepsis management recommendations into clinical care guidelines for district hospitals in resource-limited settings: the necessity to augment new guidelines with future research. BMC Med. 2013;11:107. doi: 10.1186/1741-7015-11-107 pmid: 23597160
31	Nicks B, Henley J, Mfinanga J, Mantheya D. Neurologic emergencies in resource-limited settings: A review of stroke care considerations. Afr J Emerg Med. 2014;5(1):37-44. doi: 10.1016/j.afjem.2014.06.002
32	Chiang CY, Ait-Khaled N, Bissell K, Enarson DA. Management of asthma in resource-limited settings: role of low-cost corticosteroid/beta-agonist combination inhaler. Int J Tuberc Lung Dis. 2015;19(2):129-36. doi: 10.5588/ijtld.14.0363 pmid: 25574908

Norepinephrine	Dobutamine	Vacant	Phenylephrine	Hydrocortisone
Adenosine	Metoprolol^*	Verapamil	Procainamide	Magnesium
Vecuronium⁺	Etomidate	Vacant	Isoproterenol	Atropine
Epinephrine	Amiodarone	Vacant	Sodium Bicarbonate	Calcium Chloride

Glucagon	Thyroxine	Oxytocin	Thiamine	Optional
Valproate	Levetiracetam	Phenytoin	Pyridoxine	Furosemide
Albuterol	Ipratropium	Racemic Epinephrine	Dexamethasone	Diphenhydramine
Labetalol	Nicardipine	Hydralazine	Naloxone	Glucose

Item	Pediatric sizes	Adult sizes
Oral airway	0, 1, 2	3, 4, 5
Laryngoscope handle	Small	Large
Laryngoscope blade	Straight 0, 1, 2 Curved 2	Straight 3, 4 Curved 3, 4
Endotracheal tube	2.5 to 6.5	7 to 9.5
Stylet	3, 6	14, 16
Nasal trumpet	12-22 F	24-34 F
Laryngeal mask airway	1, 2	3, 4, 5
Tracheostomy tube	2.5-6.5	7-10
Nasogastric tube	8-12	14-18
Bougie	10 F	15 F

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