Case: While performing a 'code blue' on a patient, an arterial line can not be obtained. What would be the best way to determine the efficacy of resuscitation?
Answer: Venous Blood Gas (VBG)
Arterial blood gas (ABG) analysis helps evaluate the clinical condition of critically ill patients; however, arterial puncture or the insertion of an arterial catheter may not be feasible or available in many situations. The VBG is easier, quicker, and safer to obtain, and is associated with significantly less patient pain. It would be convenient for the physician and patient to replace the ABG with the VBG for analysis of base excess (acidosis). In code situations, VBG is a better indicator of overall acidosis. If VBG results are normal, ABG analysis should not be necessary. Conversely, abnormal venous levels predicted abnormal arterial values. A venous pH of 7 or lower, for example, predicted an arterial pH of 7.2 or lower.
In cardiac arrest victims, the disparity between arterial and venous values is even greater. During cardiac arrest, tissue hypoxia is all but certain and is reflected by lower pH and higher PCO2 on the venous side.
#hemodynamics
#acid-base
References:
1. Kelly AM. Can VBG analysis replace ABG analysis in emergency care? Emerg Med J. 2016 Feb;33(2):152-4. doi: 10.1136/emermed-2014-204326. Epub 2014 Dec 31. PMID: 25552544.
2. Bloom BM, Grundlingh J, Bestwick JP, Harris T. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med. 2014 Apr;21(2):81-8. doi: 10.1097/MEJ.0b013e32836437cf. PMID: 23903783.
3. Giani D, Santoro MC, Gabrielli M, Di Luca R, Malaspina M, Lumare M, Scatà LA, Pala M, Manno A, Candelli M, Covino M, Gasbarrini A, Franceschi F. The Role of Venous Blood Gas Analysis in Critical Care: A Narrative Review. Medicina (Kaunas). 2025 Jul 24;61(8):1337. doi: 10.3390/medicina61081337. PMID: 40870384; PMCID: PMC12387505.
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