A National Survey on Interhospital Transport of Children in Cardiac Arrest

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. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). 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 Hartwell Foundation, and the NIH; she received funding from Zoll Medical Corporation (honorarium and travel expenses as a consultant); she disclosed that she and her co-investigators have a patent for intellectual property related to educational technology created to make simulations more realistic; they have a nonexclusive licensing agreement with Zoll Medical Corporation with the potential for royalties to generate money, none to date; and National Medical Consultants (subject matter expert consultant for medical legal work). Dr. Shaffner received funding from Wolters Kluwer. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: cnicule1@jhmi.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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