Stability of Drugs Used in Helicopter Air Medical Emergency Services: An Exploratory Study

Air Med J. 2016 Jul-Aug;35(4):247-50. doi: 10.1016/j.amj.2016.02.001. Epub 2016 Apr 16.

Abstract

Objective: Transportation by air exposes drugs used in emergency medical services to vibrations. The aim of the study was to determine whether or not vibrations caused by a helicopter induce the degradation of 5 drugs used in this setting.

Methods: A longitudinal study in an operating medical helicopter along with a worst case was conducted. The studied drugs were 3 drugs labeled for refrigeration (cisatracurium, lorazepam, and succinylcholine) and 2 albumin solutions (human albumin 4% and 20%). These drugs were stored for 4 months according to the following conditions: inside a helicopter, worst case with exposure to extreme vibrations, at room temperature, and according to manufacturers' recommendations. Samples were analyzed with validated high-performance liquid chromatography assay methods. A drug was considered stable if the remaining drug content was above 90% of the label claim. Except for the albumin solutions, visual inspection was used to determine instability by the formation of aggregates.

Results: Only the samples stored at room temperature became unstable after 4 months. No difference in extreme foaming was observed in the albumin solutions.

Conclusions: These data suggest that the effect of degradation of drugs caused by vibrations is negligible. Temperature was observed as the main cause of drug degradation.

MeSH terms

  • Air Ambulances*
  • Albumins / chemistry*
  • Atracurium / analogs & derivatives*
  • Atracurium / chemistry
  • Chromatography, High Pressure Liquid
  • Drug Stability
  • Emergency Medical Services
  • Humans
  • Longitudinal Studies
  • Lorazepam / chemistry*
  • Succinylcholine / chemistry*
  • Temperature*
  • Vibration*

Substances

  • Albumins
  • Atracurium
  • Succinylcholine
  • Lorazepam
  • cisatracurium