Air transfer of patients with intraaortic balloon pump support: Swiss experience and recommendations

Berset, Andreas; Albrecht, Roland; Ummenhofer, Wolfgang; Erne, Jean-Jacques; Zuercher, Mathias

doi:10.4414/smw.2012.13552

Cited by 4 publications

(5 citation statements)

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“…In the case of IABP transports, a number of different staffing models have been described in the literature, including physician/paramedic/perfusionist, physician/paramedic, nurse/paramedic, and paramedic/paramedic. [7][8][9][10] A case series of IABP transports performed in a Canadian service by specially-trained critical care paramedics, each with a minimum of 24 hours of IABP-specific training, illustrates that targeted experience and instruction can allow for the safe transport of IABP patients with a non-provider staffing model. 9 Our data are also consistent with the conclusion of Benson, et al, that an appropriately-trained 2member crew can safely transport patients with Impella devices, but the range and frequency of need for critical care evaluation and intervention in our study simultaneously highlight the need for a high degree of CCTM team member expertise and training for safe transport of these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Reflecting the importance of management during transfer, four case series of IABPsupported patients transported by helicopter air ambulance (HAA) have been published. [7][8][9][10] For Impellasupported patients, the existing literature identified in a 2019 systematic review was limited to a case report of two Impella-supported patients transferred by HAA. 11,12 A more recent case series included 16 HAA Impella transports, but reported findings across a mixed population of mostly ground ambulance transports and with ∼40% of patients receiving ECMO support in addition to Impella support.…”

Section: Introductionmentioning

confidence: 99%

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Management of patients with impella devices or intra-aortic balloon pumps during helicopter air ambulance transport in observational data

et al. 2023

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Introduction Placement of percutaneous ventricular support devices such as an intraaortic balloon pump (IABP) or Abiomed Impella device can treat severe cardiogenic shock. Critical care transport medicine (CCTM) providers frequently manage patients supported by these devices during interfacility transfers, often using a helicopter air ambulance (HAA). An understanding of patient needs and management during transport is essential to informing crew configuration and training, and this study adds to the limited existing data on the HAA transport of this complex patient population. Methods We performed a retrospective chart review of all HAA transports of patients with an IABP ( n = 38) or Impella ( n = 11) device at a single CCTM program from 2016 to 2020. We evaluated transport times and composite variables for the frequency of adverse events, condition changes requiring critical care evaluation, and critical care interventions. Results In this observational cohort, patients with an Impella device more frequently had an advanced airway and at least 1 vasopressor or inotrope active prior to transport. While flight times were similar, CCTM teams remained at referring facilities longer for patients with an Impella device (99 vs 68 minutes; p = 0.0097). Compared to patients with an IABP, patients with an Impella device more frequently had a condition change requiring critical care evaluation (100% vs 42%; p = 0.0005) and more frequently received critical care interventions (100% vs 53%; p = 0.0037). Adverse events were uncommon and did not differ for patients with an Impella device compared to an IABP (27% vs 11%; p = 0.178). Conclusion Patients requiring mechanical circulatory support with IABP and Impella devices frequently require critical care management during transport. Clinicians should ensure the CCTM team has appropriate staffing, training, and resources to meet the critical care needs of these high acuity patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of patients with impella devices or intra-aortic balloon pumps during helicopter air ambulance transport in observational data

et al. 2023

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“… Severe trauma patients with penetrating chest injuries, multisystem injuries, crush injuries, age less than 12 years or more than 55 years or patients with unstable vital signs Patients with acute coronary syndrome in urgent need of revascularisation procedure, cardiac tamponade with haemodynamic compromise, cardiogenic shock in need of intra-aortic balloon pump or other assist devices Patients due to receive organ transplant Critically ill high-risk medical or surgical patients, for example, those on high vasopressors, special modes of ventilation, requiring hyperbaric oxygen therapy or with surgical emergencies such as aortic dissection with haemodynamic compromise. [ 20 21 22 ] …”

Section: Key Elements Of Patient Transfermentioning

confidence: 99%

“…Critically ill high-risk medical or surgical patients, for example, those on high vasopressors, special modes of ventilation, requiring hyperbaric oxygen therapy or with surgical emergencies such as aortic dissection with haemodynamic compromise. [ 20 21 22 ]…”

Section: Key Elements Of Patient Transfermentioning

confidence: 99%

Inter-hospital and intra-hospital patient transfer: Recent concepts

2016

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The intra- and inter-hospital patient transfer is an important aspect of patient care which is often undertaken to improve upon the existing management of the patient. It may involve transfer of patient within the same facility for any diagnostic procedure or transfer to another facility with more advanced care. The main aim in all such transfers is maintaining the continuity of medical care. As the transfer of sick patient may induce various physiological alterations which may adversely affect the prognosis of the patient, it should be initiated systematically and according to the evidence-based guidelines. The key elements of safe transfer involve decision to transfer and communication, pre-transfer stabilisation and preparation, choosing the appropriate mode of transfer, i.e., land transport or air transport, personnel accompanying the patient, equipment and monitoring required during the transfer, and finally, the documentation and handover of the patient at the receiving facility. These key elements should be followed in each transfer to prevent any adverse events which may severely affect the patient prognosis. The existing international guidelines are evidence based from various professional bodies in developed countries. However, in developing countries like India, with limited infrastructure, these guidelines can be modified accordingly. The most important aspect is implementation of these guidelines in Indian scenario with periodical quality assessments to improve the standard of care.

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“…The critical conditions where air transport is commonly used include patients on vasopressors, ventricular assist device or sophisticated ventilator support; patients in urgent need of hyperbaric oxygen therapy (carbon monoxide poisoning, vascular gas embolism) or toxicology services (severe poisoning, drug overdose) or emergency dialysis; surgical emergencies such as aortic dissection or gastrointestinal hemorrhage with hemodynamic instability. [53545556] …”

Section: Modes Of Transfermentioning

confidence: 99%

When place and time matter: How to conduct safe inter-hospital transfer of patients

Sethi

Subramanian

2014

Saudi J Anaesth

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Inter-hospital transfer (IHT) of patients is often needed for diagnostic or therapeutic interventions. However, the transfer process carries its own risks as a poorly and hastily conducted transfer could lead to adverse events. In this article, we have reviewed literature on the key elements of IHT process including pre-transfer patient stabilization. We have also discussed various modes of transfer, physiological effects of transfer, possible adverse events and how to avoid or mitigate these. Even critically ill-patients can be transported safely by experienced and trained personnel using appropriate equipment. The patient must be maximally stabilized prior to transfer though complete optimization may be possible only at the receiving hospital. Ground or air transport may be employed depending on the urgency, feasibility and availability. Meticulous pre-transfer check and adherence to standard protocols during the transfer will help keep the entire process smooth and event free. The transport team should be trained to anticipate and manage any possible adverse events, medical or technical, during the transfer. Coordination between the referring and receiving hospitals would facilitate prompt transfer to the definitive destination avoiding delay at the emergency or casualty. Documentation of the transfer process and transfer of medical record and investigation reports are important for maintaining continuity of medical care and for medico-legal purposes.

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Air transfer of patients with intraaortic balloon pump support: Swiss experience and recommendations

Cited by 4 publications

References 0 publications

Management of patients with impella devices or intra-aortic balloon pumps during helicopter air ambulance transport in observational data

Management of patients with impella devices or intra-aortic balloon pumps during helicopter air ambulance transport in observational data

Inter-hospital and intra-hospital patient transfer: Recent concepts

When place and time matter: How to conduct safe inter-hospital transfer of patients

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