Safe long-distance interhospital ground transfer of critically ill patients with acute severe unstable respiratory and circulatory failure
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Objective. To assess the safety of long-distance ground interhospital transport of critically ill patients with the most severe unstable respiratory failure after establishment of a dedicated transport system.
Design and setting. Cohort study, retrospective chart review in 13 hospitals and intensive care units (ICU) in Finland, and a tertiary referral center and ICU of a university hospital.
Patients. 66 consecutive critically ill patients who were transferred to our ICU from 13 different ICUs in Finland because of severe, progressive respiratory failure, 52 (79%) with acute respiratory distress syndrome.
Measurements and results. Major complications during transfer and patients' oxygenation. The median transfer distance was 161 km (range 120–460 km). Drugs for cardiovascular support were infused in 59 patients (89%) during transfer. Fourteen patients (21%) were transferred in prone position because of life-threatening hypoxemia. The ratio of arterial blood PaO2 and the fraction of oxygen in the ventilator was 8.5±2.7 kPa (64±20 mmHg) before transfer and 9.7±3.6 kPa (73±27 mmHg) after transfer. There were no major complications during the transfer. ICU mortality was 30%.
Conclusions. Long-distance interhospital ground transfer of even critically ill patients with severe unstable respiratory and circulatory failure is safe if a dedicated transport team and a specially equipped transport vehicle are used.
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