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Haoutar M, Pinero D, Yonis H, Cesareo E, Mezidi M, Peguet O, Tazarourte K, Pozzi M, Dubien PY, Richard JC, Bitker L. Safety of inter-facility transport strategies for patients referred for severe acute respiratory distress syndrome. BMC Emerg Med 2023; 23:129. [PMID: 37924020 PMCID: PMC10625194 DOI: 10.1186/s12873-023-00901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Inter-facility transport of patients with acute respiratory distress syndrome (ARDS) in the prone position (PP) is a high-risk situation, compared to other strategies. We aimed to quantify the prevalence of complications during transport in PP, compared to transports with veno-venous extracorporeal membrane oxygenation (VV-ECMO) or in the supine position (SP). METHODS We performed a retrospective, single center cohort study in Lyon university hospital, France. We included patients ≥ 16 years with ARDS (Berlin definition) transported to an ARDS referral center between 01/12/2016 and 31/12/2021. We compared patients transported in PP, to those transported in SP without VV-ECMO, and those transported with VV-ECMO (in SP), by a multidisciplinary and specialized medical transport team, including an emergency physician and an intensivist. The primary outcome was the rate of transport-related complications (hypoxemia, hypotension, cardiac arrest, cannula or tube dislodgement) in each study groups, compared using a Fisher test. RESULTS One hundred thirty-four patients were enrolled (median PaO2/FiO2 70 [58-82] mmHg), of which 11 (8%) were transported in PP, 44 (33%) with VV-ECMO, and 79 (59%) in SP. The most frequent risk factor for ARDS in the PP group was bacterial pneumonitis, and viral pneumonitis in the other 2 groups. Transport-related complications occurred in 36% (n = 4) of transports in PP, compared to 39% (n = 30) in SP and 14% (n = 6) with VV-ECMO, respectively (p = 0.33). VV-ECMO implantation after transport was not different between SP and PP patients (n = 7, 64% vs. n = 31, 39%, p = 0.19). CONCLUSIONS In the context of a specialized multi-disciplinary ARDS transport team, transport-related complication rates were similar between patients transported in PP and SP, while there was a trend of lower rates in patients transported with VV-ECMO.
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Affiliation(s)
- Malik Haoutar
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - David Pinero
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Hodane Yonis
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Eric Cesareo
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Mehdi Mezidi
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Olivier Peguet
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Karim Tazarourte
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- INSERM 1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - Matteo Pozzi
- INSERM 1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
- Service de Chirurgie Cardiaque, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Yves Dubien
- SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Service de Médecine d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, Inserm, CREATIS UMR 5220, U1294, Villeurbanne, France
| | - Laurent Bitker
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, 104, Grande Rue de La Croix Rousse, 69004, Lyon, France.
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, Inserm, CREATIS UMR 5220, U1294, Villeurbanne, France.
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Olani AB, Beza L, Sultan M, Bekelcho T, Alemayehu M. Prehospital emergency medical service utilization and associated factors among critically ill COVID-19 patients treated at centers in Addis Ababa, Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001158. [PMID: 36962872 PMCID: PMC10021779 DOI: 10.1371/journal.pgph.0001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/09/2022] [Indexed: 02/04/2023]
Abstract
The majority of populations in developing countries are living in areas of no access or limited access to prehospital emergency medical services (EMS). In Addis Ababa, the reported prehospital EMS utilization were ranging from zero to thirty-eight percent. However, there is limited research on reasons for the low utilization of prehospital resources in Ethiopia. This study aimed to assess factors associated with prehospital EMS utilization among critically ill COVID-19 patients in Addis Ababa, Ethiopia. A hospital-based cross-sectional study was conducted to collect primary data from 421 COVID-19 patients in Addis Ababa between May and July 2021. Logistic regression was used to identify factors associated with prehospital service utilization. Andersen's Behavioral Model was implemented to address independent variables, including predisposing, enabling, need, and health behaviors-related variables. The level of prehospital care utilization was 87.6%. Being married [AOR 2.6(95%; CI:1.24-5.58)], belief that self-transport is quicker than the ambulance [AOR 0.13(95%; CI: 0.05-0.34)], and perceptions that ambulance provides transportation service only [AOR 0.14(95%; CI:0.04-0.45)] were predisposing factors associated with prehospital service utilization while the source of referrals [AOR 6.9(95%; CI: 2.78-17.30)], and prior knowledge on the availability of toll-free ambulance calling numbers [AOR 0.14(95%; CI: 0.04-0.45)] were identified as enabling factors. Substantial proportions of critically ill COVID-19 patients used prehospital services to access treatment centers. Prehospital EMS utilization in this study varies by predisposing and enabling factors, particularly: marital status, source of referral, prior knowledge on the availability of toll-free ambulances, belief that self-transport is quicker than ambulances, and perceptions that ambulance provides transportation service only. Our findings call for further actions to be taken by policymakers including physical and media campaigns focusing on the identified factors.
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Affiliation(s)
- Ararso Baru Olani
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
| | - Lemlem Beza
- Department of Emergency Medicine and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
| | - Menbeu Sultan
- Department of Emergency Medicine and Critical Care, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tariku Bekelcho
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
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Slagt C, Spoelder EJ, Tacken MCT, Frijlink M, Servaas S, Leijte G, van Eijk LT, van Geffen GJ. Safety during interhospital helicopter transfer of ventilated COVID-19 patients. No clinical relevant changes in vital signs including non-invasive cardiac output. Respir Res 2022; 23:256. [PMID: 36123727 PMCID: PMC9484339 DOI: 10.1186/s12931-022-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background During the COVID-19 pandemic in The Netherlands, critically ill ventilated COVID-19 patients were transferred not only between hospitals by ambulance but also by the Helicopter Emergency Medical Service (HEMS). To date, little is known about the physiological impact of helicopter transport on critically ill patients and COVID-19 patients in particular. This study was conducted to explore the impact of inter-hospital helicopter transfer on vital signs of mechanically ventilated patients with severe COVID-19, with special focus on take-off, midflight, and landing. Methods All ventilated critically ill COVID-19 patients who were transported between April 2020 and June 2021 by the Dutch ‘Lifeliner 5’ HEMS team and who were fully monitored, including noninvasive cardiac output, were included in this study. Three 10-min timeframes (take-off, midflight and landing) were defined for analysis. Continuous data on the vital parameters heart rate, peripheral oxygen saturation, arterial blood pressure, end-tidal CO2 and noninvasive cardiac output using electrical cardiometry were collected and stored at 1-min intervals. Data were analyzed for differences over time within the timeframes using one-way analysis of variance. Significant differences were checked for clinical relevance. Results Ninety-eight patients were included in the analysis. During take-off, an increase was noticed in cardiac output (from 6.7 to 8.2 L min−1; P < 0.0001), which was determined by a decrease in systemic vascular resistance (from 1071 to 739 dyne·s·cm−5, P < 0.0001) accompanied by an increase in stroke volume (from 88.8 to 113.7 mL, P < 0.0001). Other parameters were unchanged during take-off and mid-flight. During landing, cardiac output and stroke volume slightly decreased (from 8.0 to 6.8 L min−1, P < 0.0001 and from 110.1 to 84.4 mL, P < 0.0001, respectively), and total systemic vascular resistance increased (P < 0.0001). Though statistically significant, the found changes were small and not clinically relevant to the medical status of the patients as judged by the attending physicians. Conclusions Interhospital helicopter transfer of ventilated intensive care patients with COVID-19 can be performed safely and does not result in clinically relevant changes in vital signs. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02177-5.
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Affiliation(s)
- Cornelis Slagt
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands. .,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Eduard Johannes Spoelder
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marijn Cornelia Theresia Tacken
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maartje Frijlink
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sjoerd Servaas
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Guus Leijte
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Lucas Theodorus van Eijk
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Geert Jan van Geffen
- Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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Analyse des Weaningprozesses bei Intensivpatienten im Hinblick auf Dokumentation und Verlegung in weiterbehandelnde Einheiten. Med Klin Intensivmed Notfmed 2022; 118:269-276. [PMID: 35816213 PMCID: PMC9272645 DOI: 10.1007/s00063-022-00941-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022]
Abstract
Hintergrund und Fragestellung Die Entwöhnung von Beatmungsgeräten wird nicht immer auf der primär behandelnden Intensivstation abgeschlossen. Die Weiterverlegung in andere Behandlungseinrichtungen stellt einen sensiblen Abschnitt in der Behandlung und Rehabilitation des Weaningpatienten dar. Ziel der vorliegenden Studie war die Untersuchung des Überleitungsmanagements und des Interhospitaltransfers von Weaningpatienten unter besonderer Berücksichtigung der Dokumentationsqualität. Methodik Es erfolge eine retrospektive Datenanalyse eines Jahrs (2018) auf 2 Intensivstationen eines Universitätsklinikums. Eingeschlossen wurden alle beatmeten Patienten mit folgenden Tracerdiagnosen: COPD, Asthma, Polytrauma, Pneumonie, Sepsis, ARDS und Reanimation (Beatmung > 24 h). Ergebnisse Insgesamt konnten 750 Patienten in die Untersuchung eingeschlossen werden (Alter 64 [52, 8–76; Median, IQR]; 32 % weiblich). Davon waren 48 (6,4 %) Patienten zum Zeitpunkt der Verlegung nicht entwöhnt (v. a. Sepsis und ARDS). Die Routinedokumentation war bei den Abschnitten „Spontaneous Breathing Trial“, „Bewertung der Entwöhungsbereitschaft“ und „vermutete Entwöhnbarkeit“ ausreichend, um die Erfüllung der Parameter der S2k-Leitlinie „Prolongiertes Weaning“ adäquat zu beurteilen. Vorwiegend wurden diese Patienten mit Tracheostoma (76 %) in Rehabilitationskliniken (44 %) mittels spezialisierten Rettungsmitteln des arztbegleiteten Patiententransports verlegt (75 %). Diskussion Die Verlegung nicht entwöhnter Patienten nach initialem Intensivaufenthalt ist ein relevantes Thema für den Interhospitaltransfer. Die Routinedokumentation eines strukturierten Weaningprozesses ist in Kernelementen ausreichend, um den Weaningprozess lückenlos zu beschreiben. Dies ist für die Kontinuität in der Weiterbehandlung dieser Patienten von großer Bedeutung.
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Évacuations sanitaires aériennes collectives du service de santé des Armées français – MoRPHEE et MEROPE – au profit de patients en syndrome de détresse respiratoire aigu lié à la COVID-19. MÉDECINE DE CATASTROPHE - URGENCES COLLECTIVES 2022. [PMCID: PMC8536524 DOI: 10.1016/j.pxur.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Après son apparition en Chine à la fin de 2019, l’épidémie de SARS Cov2 (ou COVID-19) a rapidement provoqué le risque d’une saturation des ressources en soins intensifs dans les régions touchées. La répartition de la maladie entre les différents territoires étant hétérogène, le recours à la réalisation des transferts de patients depuis des régions saturées vers des régions non saturées s’est imposé. Des missions d’évacuations aéromédicales collectives de patients atteints de COVID-19 ont été réalisées par les équipes du service de santé des Armées et de l’Armée de l’air français. Deux dispositifs ont été déployés : les modules MoRPHEE sur le vecteur Airbus A330 PHENIX et les modules MEROPE sur le vecteur Airbus A400 M ATLAS. C’est un total de 59 patients en SDRA lié à la COVID-19 qui ont pu bénéficier de ces transferts entre mars et novembre 2020.
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Beaussac M, Boutonnet M, Koch L, Paris R, Di Filippo J, Distinguin B, Murris S, Dupre HL, Muller V, Turc J. Oxygen Management During Collective Aeromedical Evacuation of 36 COVID-19 Patients With ARDS. Mil Med 2021; 186:e667-e671. [PMID: 33211849 PMCID: PMC7717260 DOI: 10.1093/milmed/usaa512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/19/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The ongoing coronavirus disease-2019 pandemic leads to the saturation of critical care facilities worldwide. Collective aeromedical evacuations (MEDEVACS) might help rebalance the demand and supply of health care. If interhospital transport of patients suffering from ARDS is relatively common, little is known about the specific challenges of collective medevac. Oxygen management in such context is crucial. We describe our experience with a focus on this resource. METHODS We retrospectively analyzed the first six collective medevac performed during the coronavirus disease-2019 pandemic by the French Military Health Service from March 17 to April 3, 2020. Oxygen management was compliant with international guidelines as well as aeronautical constraints and monitored throughout the flights. Presumed high O2 consumers were scheduled to board the last and disembark the first. RESULTS Thirty-six mechanically ventilated patients were successfully transported within Europe. The duration of onboard ventilation was 185 minutes (145-198.5 minutes), including the flight, the boarding and disembarking periods. Oxygen intake was 1,650 L per patient per flight (1,350-1,950 L patient per flight) and 564 L per patient per hour (482-675 L per patient-1 per hour) and surpassed our anticipation. As anticipated, presumed high O2 consumers had a reduced ventilation duration onboard. The estimations of oxygen consumptions were frequently overshot, and only two hypoxemia episodes occurred. CONCLUSION Oxygen consumption was higher than expected, despite anticipation and predefined oxygen management measures, and encourages to a great caution in the processing of such collective medevac missions.
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Affiliation(s)
- Madeleine Beaussac
- 160th Military Medical Unit, 10th Military Medical Center, Istres 13800, France
| | - Mathieu Boutonnet
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Percy, Clamart 92140, France
| | - Lionel Koch
- Bacteriology Unit, French Armed Forces Biomedical Research Institute (IRBA), Bretigny sur Orge 91220, France
| | - Raphael Paris
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Laveran, Marseille 13000, France
| | - Julia Di Filippo
- 160th Military Medical Unit, 10th Military Medical Center, Istres 13800, France
| | - Berangère Distinguin
- 158th Military Medical Unit, 10th Military Medical Center, Salon de Provence 13661, France
| | - Sophie Murris
- 148th Military Medical Unit, 9th Military Medical Center, Hyeres 83400, France
| | - Henri-Louis Dupre
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Saint-Anne, Toulon 83000, France
| | - Violaine Muller
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Percy, Clamart 92140, France
| | - Jean Turc
- Intensive Care Unit and Anesthesiology Department, Military Teaching Hospital Desgenettes, Lyon 69003, France.,Intensive Care Unit and Anesthesiology Department, Edouard Herriot Hospital, Lyon 69437, France
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Painvin B, Messet H, Rodriguez M, Lebouvier T, Chatellier D, Soulat L, Ehrmann S, Thille AW, Gacouin A, Tadie JM. Inter-hospital transport of critically ill patients to manage the intensive care unit surge during the COVID-19 pandemic in France. Ann Intensive Care 2021; 11:54. [PMID: 33788010 PMCID: PMC8011063 DOI: 10.1186/s13613-021-00841-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/20/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic led authorities to evacuate via various travel modalities critically ill ventilated patients into less crowded units. However, it is not known if interhospital transport impacts COVID-19 patient's mortality in intensive care units (ICUs). A cohort from three French University Hospitals was analysed in ICUs between 15th of March and the 15th of April 2020. Patients admitted to ICU with positive COVID-19 test and mechanically ventilated were recruited. RESULTS Among the 133 patients included in the study, 95 (71%) were male patients and median age was 63 years old (interquartile range: 54-71). Overall ICU mortality was 11%. Mode of transport included train (48 patients), ambulance (6 patients), and plane plus helicopter (14 patients). During their ICU stay, 7 (10%) transferred patients and 8 (12%) non-transferred patients died (p = 0.71). Median SAPS II score at admission was 33 (interquartile range: 25-46) for the transferred group and 35 (27-42) for non-transferred patients (p = 0.53). SOFA score at admission was 4 (3-6) for the transferred group versus 3 (2-5) for the non-transferred group (p = 0.25). In the transferred group, median PaO2/FiO2 ratio (P/F) value in the 24 h before departure was 197 mmHg (160-250) and remained 166 mmHg (125-222) in the first 24 h post arrival (p = 0.13). During the evacuation 46 (68%) and 21 (31%) of the patients, respectively, benefited from neuromuscular blocking agents and from vasopressors. Transferred and non-transferred patients had similar rate of nosocomial infections, 37/68 (54%) versus 34/65 (52%), respectively (p = 0.80). Median length of mechanical ventilation was significantly increased in the transferred group compared to the non-transferred group, 18 days (11-24) and 14 days (8-20), respectively (p = 0.007). Finally, ICU and hospital length of stay did not differ between groups. CONCLUSIONS In France, inter-hospital evacuation of COVID-19 ventilated ICU patients did not appear to increase mortality and therefore could be proposed to manage ICU surges in the future.
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Affiliation(s)
- Benoit Painvin
- Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
| | - Hélène Messet
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 27044, Tours cedex 9, France
| | - Maeva Rodriguez
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, CS 90577, 86000, Poitiers, France
| | - Thomas Lebouvier
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Delphine Chatellier
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, CS 90577, 86000, Poitiers, France
| | - Louis Soulat
- Service Samu-Smur-Urgences médico-chirurgicales adultes, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
| | - Stephane Ehrmann
- Service de Médecine Intensive et Réanimation, CIC INSERM 1415, CRICS-Triggersep Research Network, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 27044, Tours cedex 9, France
- Centre d'étude des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Arnaud W Thille
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, CS 90577, 86000, Poitiers, France
| | - Arnaud Gacouin
- Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France
- Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - Jean-Marc Tadie
- Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
- Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France.
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Patient Safety during ECMO Transportation: Single Center Experience and Literature Review. Emerg Med Int 2021; 2021:6633208. [PMID: 33688436 PMCID: PMC7920709 DOI: 10.1155/2021/6633208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) has been proven to support in lifesaving rescue therapy. The best outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams. Aim The aim of this study was to analyze the safety of ECMO support during medical transfer on the basis of our experience developed on innovation cooperation and review of literature. Methods A retrospective analysis of our experience of all ECMO-supported patients transferred from regional hospital of the referential ECMO center between 2015 and 2020 was carried out. Special attention was paid to transportation-related mortality and morbidity. Moreover, a systematic review of the Medline, Embase, Cochrane, and Google Scholar databases was performed. It included the original papers published before the end of 2019. Results Twelve (5 women and 7 men) critically ill ECMO-supported patients with the median age of 33 years (2-63 years) were transferred to our ECMO center. In 92% (n = 11) of the cases venovenous and in 1 case, venoarterial supports were applied. The median transfer length was 45 km (5-200). There was no mortality during transfer and no serious adverse events occurred. Of note, the first ECMO-supported transfer had been proceeded by high-fidelity simulations. For our systematic review, 68 articles were found and 22 of them satisfied the search criteria. A total number of 2647 transfers were reported, mainly primary (90%) and as ground transportations (91.6%). A rate of adverse events ranged from 1% through 20% but notably only major complications were mentioned. The 4 deaths occurred during transport (mortality 0.15%). Conclusions Our experiences and literature review showed that transportation for ECMO patients done by experienced staff was associated with low mortality rate but life-threatening adverse events might occur. Translational simulation is an excellent probing technique to improve transportation safety.
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Collective aeromedical transport of COVID-19 critically ill patients in Europe: A retrospective study. Anaesth Crit Care Pain Med 2021; 40:100786. [PMID: 33232835 PMCID: PMC7680057 DOI: 10.1016/j.accpm.2020.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/10/2020] [Accepted: 11/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In early 2020, the coronavirus disease 2019 (COVID-19) pandemic outbreak has posed the risk of critical care resources overload in every affected country. Collective interhospital transport of critically ill COVID-19 patients as a way to mitigate the localised pressure from overloaded intensive care units at a national or international level has not been reported yet. The aim of this study was to provide descriptive data about the first six collective aeromedical evacuation (MEDEVAC) of COVID-19 patients performed within Europe. METHODS This retrospective study included all adult patients transported by the first six collective MEDEVAC missions for COVID-19 patients performed within Europe on the 18th, 21st, 24th, 27th, 31st of March and the 3rd of April 2020. RESULTS Thirty-six patients with acute respiratory distress syndrome (ARDS) were transported aboard six MEDEVAC missions. The median duration of mechanical ventilation in ICU before transportation was 4 days (3-5.25). The median PaO2/FiO2 ratio obtained before, during the flight and at day 1 after the transport was 180 mmHg (156-202,5), 143 mmHg (118,75-184,75) and 174 mmHg (129,5-205,5), respectively, with no significant difference. The median norepinephrine infusion rate observed before, during the flight and at day 1 after the transport was 0,08 µg/kg-1. min-1 (0,00-0,20), 0,08 (0,00-0,25), and 0,07 (0,03-0,18), respectively, with no significant difference. No life-threatening event was reported. CONCLUSION Collective aero-MEDEVAC of COVID-19 critically ill patients could provide a reliable solution to help control the burden of the disease at a national or international level.
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Beaussac M, Distinguin B, Turc J, Boutonnet M. Retour d’expérience des six évacuations sanitaires aériennes collectives MoRPHEE durant la pandémie de Covid-19. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Après son apparition en Chine à la fin de 2019, l’épidémie de coronavirus 2019 (Covid-19) a rapidement provoqué le risque d’une saturation des ressources en soins intensifs dans chaque pays touché. La répartition de la maladie entre les différents territoires est hétérogène. Le transport interhospitalier sur longue distance de patients atteints de Covid-19 dans le but de limiter la pression sur les unités de soins intensifs au niveau national ou international n’a pas encore été décrit. L’objectif de cet article était de fournir des données descriptives des six missions d’évacuation aéromédicale collective (Evasan) de patients atteints de Covid-19 réalisées en Europe et sur le territoire national français les 18, 21, 24, 27, 31 mars et 3 avril 2020 grâce au dispositif MoRPHEE. Trente-six patients souffrant de syndrome de détresse respiratoire aiguë (SDRA) ont été évacués durant six missions d’évacuations sanitaires collectives. Le SDRA était modéré (rapport PaO2/FiO2> 100 et ≤ 200) chez 24 patients et léger (rapport PaO2/FiO2> 200 et ≤ 300) chez 12 patients. La durée médiane de la ventilation mécanique en soins intensifs avant le transport était de quatre jours (interquartile [IQ] : 3‒5). Le rapport médian PaO2/FiO2était de 180 mmHg (IQ : 156‒202). Le débit médian de perfusion de noradrénaline était de 0,08 μg/kg par min. Aucune complication mettant en jeu le pronostic vital n’a été signalée. En conclusion, l’évacuation sanitaire aérienne collective de patients gravement malades de Covid-19 est une solution contribuant à contrôler le niveau de saturation du système de soins au niveau national ou international.
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11
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Richards JB, Frakes M, Saia MS, Johnson R, Wilcox SR. Changes in Oxygen Saturation and Mean Arterial Pressure With Inhaled Epoprostenol in Transport. J Intensive Care Med 2020; 36:758-765. [PMID: 32266858 DOI: 10.1177/0885066620917658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Patients with hypoxemic respiratory failure have traditionally been considered one of the riskiest patient populations to transport, given the potential for desaturation with movement. We performed a retrospective cohort study to analyze our experience using inhaled epoprostenol in transport, with a primary objective of assessing change in the oxygen saturation throughout the transport. METHODS The transport records of patients with severe hypoxemic respiratory failure or right heart failure, transported on inhaled epoprostenol, were reviewed. The primary outcome was the change in SpO2 from the start of the inhaled epoprostenol transport to the time of handover of care at the receiving institution. The secondary outcome was the change in the mean arterial pressure (MAP). RESULTS Comparing the initial SpO2 to the final, there was no significant difference in oxygenation between time 0 and the transfer of care at the receiving hospital at 91% versus 93% (interquartile range [IQR] 86.0-93.5 vs 87.5-96.0, P = .49). Comparing the SpO2 for those who had inhaled epoprostenol started by the transport team showed a larger change at 86% compared to 93% (IQR: 83.0-91.0 vs 86.5-94.5, P = .04). There was no change in the median MAP from time 0 to the end of the transport (77 vs 75 mm Hg, IQR, 67.5-84.8 vs 68.5-85.8, P = .70). CONCLUSIONS In this study, patients with severe cardiopulmonary compromise transported on inhaled epoprostenol had no significant change in their median oxygen saturations, with the overall population increasing from 91% to 93%. When inhaled epoprostenol was initiated by the transport team, the improvement was clinically and statistically significant with an increase in SpO2 from 86% to 93%, with a final oxygen saturation comparable to those who were on the medication at the time of the team's arrival.
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Affiliation(s)
- Jeremy B Richards
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | - Susan R Wilcox
- Department of Emergency Medicine, Heart Center ICU, 2348Massachusetts General Hospital, MA, USA
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12
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Krzak AM, Fowles JA, Vuylsteke A. Mobile extracorporeal membrane oxygenation service for severe acute respiratory failure - A review of five years of experience. J Intensive Care Soc 2019; 21:134-139. [PMID: 32489409 DOI: 10.1177/1751143719855207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Provision of extracorporeal membrane oxygenation as part of support escalation in severe refractory acute respiratory failure in England is provided by five specialist centres that operate within a well-defined quality and safety framework. We conducted a qualitative study of the extracorporeal membrane oxygenation retrieval service provided by one of the five centres. We analysed 176 consecutive debrief reports written between October 2013 and April 2018 by the consultant. Main identified issues were short delays in retrieval predominantly due to insufficient communication or equipment failure. All issues were addressed in subsequent practice. Our results suggest a need for improved communication between the referring intensive care unit and retrieving team. Our findings highlight the value of regular reflection-based evaluation to ensure continued provision of safe and efficient service.
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Affiliation(s)
- Ada M Krzak
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Alain Vuylsteke
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Royal Papworth Hospital, Cambridge, UK
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Ehrentraut SF, Schroll B, Lenkeit S, Ehrentraut H, Bode C, Kreyer S, Kögl F, Lehmann F, Muders T, Scholz M, Strater C, Steinhagen F, Theuerkauf NU, Weißbrich C, Putensen C, Schewe JC. Interprofessional two-man team approach for interhospital transport of ARDS-patients under extracorporeal membrane oxygenation: a 10 years retrospective observational cohort study. BMC Anesthesiol 2019; 19:19. [PMID: 30704395 PMCID: PMC6357391 DOI: 10.1186/s12871-019-0687-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/16/2019] [Indexed: 12/04/2022] Open
Abstract
Background Extra Corporeal Membrane Oxygenation (ECMO) has become an accepted treatment option for severely ill patients. Due to a limited availability of ECMO support therapy, patients must often be transported to a specialised centre before or after cannulation. According to the ELSO guidelines, an ECMO specialist should be present for such interventions. Here we describe the safety and efficacy of a reduced team approach involving one anaesthesiologist, experienced in specialised intensive care medicine, and a specialised critical care nurse. Methods This study is a 10 years retrospective, single institution analysis of all data collected between January 2007 and December 2016 from the medical records at the University Hospital Bonn, Germany. Results The Bonner mobile ECMO team was deployed in 170 cases for on-site evaluation for ECMO support therapy. 4 (2.4%) patients died prior to arrival or during the implementation of ECMO support. Of the remaining 166 patients, 126 were cannulated at the referring site, 40 were transported without ECMO. Of those, 21 were subsequently cannulated out our centre. 19 patients never received ECMO treatment. The primary indication for ECMO treatment was ARDS (159/166 patients). Veno-venous ECMO was initiated in 137, whilst 10 patients received veno-arterial ECMO treatment. Mean transportation time was 75 ± 36 min, and mean transport distance was 56 ± 57 km. In total, 26 complications were observed, three being directly transport-related. The overall survival was 55%. Conclusions Initiation of extracorporeal membrane oxygenation and subsequent transport can be safely and efficiently performed by a two-man team with good outcome. Electronic supplementary material The online version of this article (10.1186/s12871-019-0687-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Felix Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Barbara Schroll
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Stefan Lenkeit
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Heidi Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Christian Bode
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Stefan Kreyer
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Florian Kögl
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Felix Lehmann
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Thomas Muders
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Martin Scholz
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Claudia Strater
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Folkert Steinhagen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Nils Ulrich Theuerkauf
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Carsten Weißbrich
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Christian Putensen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Jens-Christian Schewe
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
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