Non-invasive blood pressure measurements are often inaccurate within the pre-hospital critical care setting, particularly in patients with hemodynamic instability which are the group in which the accuracy of vital signs is most important. In particular, it overestimated SBP and MAP at low values and underestimated them at high values.

The limitations of this study would have collectively been expected to overestimate the accuracy of NIBP, which makes the low concordance between NIBP and IBP measurements all the more concerning.

Pre-hospital clinicians should be aware that NIBP may be misleading and factor this uncertainty into their decision making.

Further work may help determine whether direct arterial pressure monitoring should have a wider role in the pre-hospital critical care environment.

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