Feasibility of Prehospital Central Venous Cannulation During Cardiac Arrest in an Ambulance

Central venous cannulation is routinely performed in hospital settings but is rarely considered in the prehospital environment, where confined workspaces and concurrent resuscitative demands may limit procedural feasibility. We conducted a simulation-based feasibility study to evaluate whether central venous cannulation could be performed during ongoing cardiac arrest resuscitation within a standard ambulance. A multidisciplinary team consisting of emergency medical services clinicians and a physician participated in repeated simulations using a resuscitation manikin. A refractory shockable cardiac arrest scenario requiring ongoing advanced cardiac life support was simulated, while airway management, medication administration, cardiac monitoring, and chest compressions continued uninterrupted. Central venous cannulation was successfully completed in all simulations using standard sterile technique. The technical aspects of cannulation were largely unchanged from hospital-based practice, and left femoral venous access was identified as the most practical site. The primary challenges were limited workspace and unfavorable ergonomics related to the fixed stretcher height, which required the operator performing cannulation to work in an awkward position. Despite these constraints, all major advanced cardiac life support interventions were maintained throughout the procedure. These findings suggest that central venous cannulation during ongoing cardiac arrest resuscitation is technically feasible within a standard ambulance environment and support further investigation into advanced vascular access procedures in prehospital critical care.