TY - JOUR
T1 - A National Survey on Interhospital Transport of Children in Cardiac Arrest
AU - Noje, Corina
AU - Bembea, Melania M.
AU - Nelson McMillan, Kristen L.
AU - Brunetti, Marissa A.
AU - Bernier, Meghan L.
AU - Costabile, Philomena M.
AU - Klein, Bruce L.
AU - Duval-Arnould, Jordan
AU - Hunt, Elizabeth A.
AU - Shaffner, Donald H.
N1 - Funding Information:
Dr. Bembea’s institution received funding from the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke and the National Science Foundation. Dr. Hunt’s institution received grant funding from the Laerdal Foundation for Acute Care Medicine, the Hart- well Foundation, and the NIH; she received funding from Zoll Medical Cor- poration (honorarium and travel expenses as a consultant); she disclosed that she and her co-investigators have a patent for intellectual property The interhospital transport of children in cardiac arrest istic; they have a nonexclusive licensing agreement with Zoll Medical Cor-related to educational technology created to make simulations more real- undergoing cardiopulmonary resuscitation (CPR) is poration with the potential for royalties to generate money, none to date; not well documented in the literature. Generally, chil- and National Medical Consultants (subject matter expert consultant for dren with out-of-hospital cardiac arrest (OHCA) are trans-The remaining authors have disclosed that they do not have any potential medical legal work). Dr. Shaffner received funding from Wolters Kluwer. ported to the nearest hospital (usually a community hospital), conflicts of interest. and subsequent transfer to a tertiary center occurs only if For information regarding this article, E-mail: cnicule1@jhmi.edu return of spontaneous circulation (ROSC) is achieved. Simi-Copyright ©2018 by the Society of Critical Care Medicine and the World larly, children with in-hospital cardiac arrest (IHCA) at a com- Federation of Pediatric Intensive and Critical Care Societies munity hospital are usually not transferred for specialized DOI: 10.1097/PCC.0000000000001768 care unless they have ROSC. An expansion of extracorporeal
Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Objectives: To describe the U.S. experience with interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Design: Self-administered electronic survey. Setting: Pediatric transport teams listed with the American Academy of Pediatrics Section on Transport Medicine. Subjects: Leaders of U.S. pediatric transport teams. Interventions: None. Measurements and Main Results: Sixty of the 88 teams surveyed (68%) responded. Nineteen teams (32%) from 13 states transport children undergoing cardiopulmonary resuscitation between hospitals. The most common reasons for transfer of children in cardiac arrest are higher level-of-care (70%), extracorporeal life support (60%), and advanced trauma resuscitation (35%). Eligibility is typically decided on a case-by-case basis (85%) and sometimes involves a short interhospital distance (35%), or prompt institution of high-quality cardiopulmonary resuscitation (20%). Of the 19 teams that transport with ongoing cardiopulmonary resuscitation, 42% report no special staff safety features, 42% have guidelines or protocols, 37% train staff on resuscitation during transport, 11% brace with another provider, and 5% use mechanical cardiopulmonary resuscitation devices for patients less than 18 years. In the past 5 years, 18 teams report having done such cardiopulmonary resuscitation transports: 22% did greater than five transports, 44% did two to five transports, 6% did one transport, and the remaining 28% did not recall the number of transports. Seventy-eight percent recall having transported by ambulance, 44% by helicopter, and 22% by fixed-wing. Although patient outcomes were varied, eight teams (44%) reported survivors to ICU and/or hospital discharge. Conclusions: A minority of U.S. teams perform interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Eligibility criteria, transport logistics, and patient outcomes are heterogeneous. Importantly, there is a paucity of established safety protocols for the staff performing cardiopulmonary resuscitation in transport.
AB - Objectives: To describe the U.S. experience with interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Design: Self-administered electronic survey. Setting: Pediatric transport teams listed with the American Academy of Pediatrics Section on Transport Medicine. Subjects: Leaders of U.S. pediatric transport teams. Interventions: None. Measurements and Main Results: Sixty of the 88 teams surveyed (68%) responded. Nineteen teams (32%) from 13 states transport children undergoing cardiopulmonary resuscitation between hospitals. The most common reasons for transfer of children in cardiac arrest are higher level-of-care (70%), extracorporeal life support (60%), and advanced trauma resuscitation (35%). Eligibility is typically decided on a case-by-case basis (85%) and sometimes involves a short interhospital distance (35%), or prompt institution of high-quality cardiopulmonary resuscitation (20%). Of the 19 teams that transport with ongoing cardiopulmonary resuscitation, 42% report no special staff safety features, 42% have guidelines or protocols, 37% train staff on resuscitation during transport, 11% brace with another provider, and 5% use mechanical cardiopulmonary resuscitation devices for patients less than 18 years. In the past 5 years, 18 teams report having done such cardiopulmonary resuscitation transports: 22% did greater than five transports, 44% did two to five transports, 6% did one transport, and the remaining 28% did not recall the number of transports. Seventy-eight percent recall having transported by ambulance, 44% by helicopter, and 22% by fixed-wing. Although patient outcomes were varied, eight teams (44%) reported survivors to ICU and/or hospital discharge. Conclusions: A minority of U.S. teams perform interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Eligibility criteria, transport logistics, and patient outcomes are heterogeneous. Importantly, there is a paucity of established safety protocols for the staff performing cardiopulmonary resuscitation in transport.
KW - cardiac arrest
KW - cardiopulmonary resuscitation
KW - interhospital transport
KW - pediatric
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U2 - 10.1097/PCC.0000000000001768
DO - 10.1097/PCC.0000000000001768
M3 - Review article
C2 - 30395025
AN - SCOPUS:85059495032
SN - 1529-7535
VL - 20
SP - E30-E36
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 1
ER -