Quality of inter-hospital transportation in 431 transport survivor patients suffering from acute respiratory distress syndrome referred to specialist centers

Abstract

BackgroundThe acute respiratory distress syndrome (ARDS) is a life-threatening condition. In special situations, these critically ill patients must be transferred to specialized centers for escalating treatment. The aim of this study was to evaluate the quality of inter-hospital transport (IHT) of ARDS patients.MethodsWe evaluated medical and organizational aspects of structural and procedural quality relating to IHT of patients with ARDS in a prospective nationwide ARDS study. The qualification of emergency staff, the organizational aspects and the occurrence of critical events during transport were analyzed.ResultsOut of 1234 ARDS patients, 431 (34.9%) were transported, and 52 of these (12.1%) treated with extracorporeal membrane oxygenation. 63.1% of transferred patients were male, median age was 54 years, and 26.8% of patients were obese. All patients were mechanically ventilated during IHT. Pressure-controlled ventilation was the preferred mode (92.1%). Median duration to organize the IHT was 165 min. Median distance for IHT was 58 km, and median duration of IHT 60 min. Forty-two patient-related and 8 technology-related critical events (11.6%, 50 of 431 patients) were observed. When a critical event occurred, the PaO2/FiO2 ratio before transport was significant lower (68 vs. 80 mmHg, p = 0.017). 69.8% of physicians and 86.7% of paramedics confirmed all transfer qualifications according to requirements of the German faculty guidelines (DIVI).ConclusionsThe transport of critically ill patients is associated with potential risks. In our study the rate of patient- and technology-related critical events was relatively low. A severe ARDS with a PaO2/FiO2 ratio < 70 mmHg seems to be a risk factor for the appearance of critical events during IHT. The majority of transport staff was well qualified. Time span for organization of IHT was relatively short. ECMO is an option to transport patients with a severe ARDS safely to specialized centers.Trial registration NCT02637011 (ClinicalTrials.gov, Registered 15 December 2015, retrospectively registered)

Interprofessional two-man team approach for interhospital transport of ARDS-patients under extracorporeal membrane oxygenation: a 10 years retrospective observational cohort study

“…The majority of incidents were related to ECMO implantation or critical condition of the patient. This finding is in accordance with the observed rate of critical events in the DACAPO study, where 59 (13.6%) critical events occurred, with 42 being patient related [24]. The observed rates of ECMO implantation related complications are also in accordance with those by Brechot et al This indicates, that out-of-centre complications are most likely secondary to the procedure itself and not the absence of a vascular surgeon in our team.…”

“…Brechot et al published a mean SOFA score of 14 (IQR 10–16), also comparable to the observed scores in our cohort [22]. Mirroring this finding are data from the DACAPO study group, who reported a mean SOFA of 11 (IQR 8–13) [24].…”

Mobile extracorporeal membrane oxygenation service for severe acute respiratory failure – A review of five years of experience

“…All issues identified in this evaluation were discussed during team debrief and addressed in subsequent practice. Prevalence of critical events reported in our evaluation was relatively low compared with results previously reported by Blecha et al, 15 who reported 9 transportation delays, 5 equipment-related and 3 transportation vehicle-related issues during retrieval of 431 patients, 52 of whom were retrieved on ECMO.…”

“…Of the total of 167 completed retrievals, 31 (17.9%) were declined ECMO following on-site review either due to perceived futility following on-site review 13 or improvement in patient's condition 14 as a result of advice given by the retrieving team 15 or improvement on conventional therapy since initial (Figure 1). The mean age of the patients was 42.1 (AE15.9) years, the mean BMI was 31.0 (AE9.1) and 98 (57%) were male.…”

Oxygen Management During Collective Aeromedical Evacuation of 36 COVID-19 Patients With ARDS

“…There is increasing evidence on interhospital transfer of ARDS patients, but these transfers have always been conducted for single patients. 6 , 7 Every interhospital or intrahospital transfer is known to be a risk period for the critically ill patient. 8 , 9 In the case of ARDS patients, interhospital transfers have been shown to be associated with minor deterioration of the patients’ condition; however, the risks are to be balanced with the expected benefits, such as the opportunity for the patient to access to specialized facilities such as extracorporeal membrane oxygenation (ECMO).…”