B25-11 Resuscitation Practice Patterns in Arterial Line Use and Cardiac Arrest During Emergency Department Encounters

Abstract Rationale Real-time hemodynamic monitoring is fundamental to high-quality resuscitation. The American Heart Association’s (AHA) Advanced Cardiovascular Life Support (ACLS) guidelines emphasize the use of invasive hemodynamic monitoring, particularly arterial pressure measurement, to guide ACLS performance for improved perfusion and outcomes. However, national data on arterial line utilization during high-acuity Emergency Department (ED) encounters remain limited. We examined whether invasive monitoring is used in high acuity ED patients to evaluate trends in ED resuscitation. Methods We conducted a repeated cross-sectional study using the Nationwide Emergency Department Sample (NEDS) from 2018-2022. Arterial line placement was identified using appropriate CPT codes. Because NEDS does not specify the location of procedures after admission, we analyzed three cohorts reflecting different levels of certainty for ED-based arterial line placement: 1) patients who expired in the ED, 2) patients with an out-of-hospital cardiac arrest (OHCA) associated ICD-10 diagnoses (identified using a validated algorithm), 3) patients with a ventricular fibrillation (VF) ICD-10 diagnosis. Quarterly arterial line utilization proportions were calculated for each cohort, and temporal trends were assessed using joinpoint regression (Joinpoint 5.4, National Cancer Institute) with quarterly percent change (QPC) estimates accounting for autocorrelation. All analyses incorporated NEDS sampling weights to generate nationally representative estimates. Results From 2018-2022, 159,389,723 ED visits were captured. Arterial lines were identified among 248,596 patients who expired in the ED, 504,788 with an OHCA diagnosis, and 48,056 with a VF diagnosis. For visits with arterial line placement, median ages (IQR) were 65 (51-76) years for ED deaths, 64 (50-75) for cardiac arrest, and 64 (53-73) for VF; females accounted for 40%, 41%, and 31% of visits, respectively. Arterial lines were placed in 1.3% of ED deaths, 0.6% of OHCA, and 0.4% of VF cases. Arterial line utilization increased across all cohorts over time: QPC 5.5% (95% CI, 4.7-6.4; p 0.001) for ED deaths, 4.9% (95% CI, 4.1-5.6; p 0.001) for cardiac arrest, and 4.5% (95% CI, 1.5-8.3; p 0.01) for VF. Discussion National arterial line utilization during ED resuscitation is increasing, reflecting evolving practice patterns toward AHA-recommended guidelines. Opportunities remain to better integrate invasive hemodynamic assessment into early ED decision-making. Because procedure timing cannot be distinguished in NEDS, arterial line use among patients who expired in the ED likely reflects true resuscitation practice trends (rather than treatment effectiveness), whereas use among OHCA and VF cohorts may include lines placed after admission, potentially confounding estimates of ED utilization. This abstract is funded by: None