Complications in critically ill adult patients’ transportations reported in the recent literature

Abstract

The transport of critically ill patients is a complex process, made up by several phases involving the healthcare professionals. It requires a careful planning for the prevention of potential complications undermining the patients' safety outside critical care environment. Literature review about complications and adverse events reported during intra and inter-hospital transport of critically ill adult patients. Intra-hospital transfers are affected by adverse events rates ranging from 22.2 to 75.7% in the published literature. Major adverse events, defined as life threatening conditions that require urgent therapeutic intervention, vary from 4.2 to 31%. Death is a rare occurrence. Adverse events during interhospital have a maximum rate of 34%. Technical incidents represent a typical feature of these transports. Authors reported problems to gas supply, ambulance electric system, equipment. There is a lack of studies about the complications related to rotary wing inter-hospital transports. While extracorporeal membrane oxygenation/extracorporeal life support patients seem to be the most complex category of critically ill to be transported outside the hospital, 11 papers revealed only 29 adverse events ranging from 0 to 17%. No deaths were recorded. Currently, research must explore more accurately how much transports affect the outcome of patients, and what are the most appropriate time-frames to assess the consequences of transfers on patients' clinical conditions.

A comparison of the content taught in critical care transportation modules across South African bachelor’s degrees in emergency medical care

“…This shortfall is likely reflected in the high rates of adverse events described in previous studies investigating the transportation of critically ill or injured patients when performed by practitioners who lack advanced or specialised training. [2 , 19 , 20] Importantly, adverse events are often underreported in emergency care and these rates are likely underestimating the true incidence. [21] Our study indicates that there is consistency between the different universities on taught content, and variability between knowledge and skill across the institutions is therefore unlikely to explain such high rates.…”

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

“…[1] Studies have shown that AEs during CCTs are significant and proportionate to the level of training and experience of the transferring practitioner. [5,6] A literature review in 2015, based on 33 recently published studies on complications during CCTs of adult patients, found that inter-hospital transfers had an AE rate as high as 34%. [5] This appears to be corroborated by a local study among paediatric admissions at a tertiary hospital which showed an AE rate of between 27% and 36%.…”

“…[5,6] A literature review in 2015, based on 33 recently published studies on complications during CCTs of adult patients, found that inter-hospital transfers had an AE rate as high as 34%. [5] This appears to be corroborated by a local study among paediatric admissions at a tertiary hospital which showed an AE rate of between 27% and 36%. [7] Further to this, a local paper published as early as 2001 a recommendation that transferring practitioners receive additional training in the care of neonates to avoid in-transit AE.…”

“…[5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting.…”

“…[4] Studies have shown that adverse events (AEs) during CCTs are significant and proportionate to the level of training and experience of the transferring practitioner. [5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting. [7] The study found that the transfers were predominantly undertaken by paramedics (82%) via road ambulance (76%).…”