Inter-hospital transport of the child with critical cardiac disease

Abstract

Centralisation of services such as cardiology, cardiac surgery, and intensive care in many parts of the world has resulted in the need to safely transport children with critical cardiac disease from local hospitals to specialist centres for diagnostic, surgical, and/or critical care intervention. The transport of this cohort of children, whether locally or internationally, can present specific clinical and logistical challenges. An international group of clinicians with expertise in cardiac care and critical care transport worked together to summarise current clinical practice relating to key areas of transport. This expert review covers the transport of the child with critical cardiac disease in terms of referral triage and advice, enabling optimal management of locally available resources, clinical stabilisation before transport, international air transport, transport considerations in low-and middleincome countries, and the transport of children with specific cardiac conditions. As specialist services are centralised to fewer large centres, the need for safe and timely inter-hospital transport of children with critical cardiac disease is only expected to rise in the future. The key principles outlined in this review will be helpful for practitioners in global settings who are, or might be, involved in transporting children between hospitals.

Impact of transport on arrival status and outcomes in newborns with heart disease: a low–middle-income country perspective

“…Indeed, despite the large volume of work on neonatal transport, in general, specific issues pertaining to transportation of neonates with cardiac emergencies have received limited attention even in high-income nations. 17,21,26,27 The vast majority of babies with CHD are born in low-and middle-income countries and, most die without access to definitive treatment. 19 Antenatal diagnosis of CHD is generally not available.…”

Pediatric Cardiac Intensive Care Society Statement: caring for children with critical cardiac disease across the globe

“…Truly excellent paediatric cardiac programmes have evolved over time in all continents of the globe, finding their own pathways to deliver outstanding care for children with heart disease via a range of means. In addition, paediatric cardiac care has been supported to develop excellence by fostering inter-institutional partnerships, the examples of which -Jamaica, Mexico, India, and Viet Namare discussed in the Global Statement by Bastero et al 6 ; with the input of "missions" or visiting paediatric cardiac surgical trips, a detailed account of which is provided by Molloy et al 7 ; and in finding creative ways to care for critically ill children during transportation from one place to another, as discussed by Ramnarayam et al 8 Finally, a range of mechanisms have evolved to measure, monitor, and ultimately improve patient outcomes, this being a general principle that has very wide support within the PCICS organisation. As discussed in the article by Hickey et al, 9 these include the development of multi-institutional clinical databases to which centres can add patient data in order to compare their outcomes with those of others, the use of common and consistent methodologies to adjust for the severity of case mix, the identification of quality metrics to benchmark individual centre performance, and the fostering of a commitment to using improvement science methodologies.…”

“…Truly excellent paediatric cardiac programmes have evolved over time in all continents of the globe, finding their own pathways to deliver outstanding care for children with heart disease via a range of means. In addition, paediatric cardiac care has been supported to develop excellence by fostering inter-institutional partnerships, the examples of which – Jamaica, Mexico, India, and Viet Nam – are discussed in the Global Statement by Bastero et al 6 ; with the input of “missions” or visiting paediatric cardiac surgical trips, a detailed account of which is provided by Molloy et al 7 ; and in finding creative ways to care for critically ill children during transportation from one place to another, as discussed by Ramnarayam et al 8 …”

Do infants with transposition of the great arteries born outside a specialist centre have different outcomes?

“…These specialised paediatric transport teams have been established over the past 20 years across the United Kingdom to transfer critically ill children from the district general hospital into tertiary paediatric ICU 9 and are shown to improve the outcomes of critically ill children. 10 With the move towards increasing centralisation of specialist services in the United Kingdom, such as paediatric cardiac surgical centres, the requirement for inter-hospital transport of infants with cardiac disease is only likely to increase.…”

“…10 With the move towards increasing centralisation of specialist services in the United Kingdom, such as paediatric cardiac surgical centres, the requirement for inter-hospital transport of infants with cardiac disease is only likely to increase. 9 This pilot study is the first United Kingdom study to examine the impact of transport times in infants with transposition of the great arteries in relation to patient outcomes. We aimed to examine the outcomes of infants who were externally retrieved from district general hospitals to those born in the tertiary maternity unit adjacent to the specialist paediatric ICU in the South West of England and South Wales.…”