New whole-blood testing for laboratory support of critical care at cardiac transplant centers and US hospitals.

Abstract

Whole-blood analytical techniques include ion-specific, substrate-specific, amperometric, and impedance electrodes. These allow direct measurement of critical analytes simultaneously in whole blood without centrifugation, resulting in a response time of 2 to 5 minutes. Cardiac transplantation centers rely heavily on whole-blood instruments to provide rapid response tests essential for cardiovascular management. A survey of 81 blood gas laboratories in 25 cardiac transplantation centers and 73 blood gas laboratories in 36 general hospitals showed an increase in testing for potassium, free calcium, and glucose by blood gas laboratories since 1982 and extensive use of satellite laboratories near areas serving critically ill patients. The following three recent developments are improving the availability of laboratory results: (1) direct whole-blood measurement is gaining acceptance, (2) instrumentation designed specifically for rapid critical care profiling is being used extensively, and (3) testing is moving closer to patients. These trends suggest a significant change in laboratory support of critical care in the United States.