Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma*

Abstract

Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.

Survival After Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation in Children

“…In the intra-arrest transport group, 69.0% received epinephrine and 34.1% underwent AAM. It is possible that a greater proportion of patients with intra-arrest transport subsequently underwent Advanced Life Support interventions after hospital arrival, which might have partially offset the theoretical risk of inadequate CPR metrics during transport . It is also possible that increasing prehospital AAM would not only improve on-scene CPR quality but could improve the safety of transport by facilitating higher-quality oxygenation and ventilation.…”

Cardiopulmonary Resuscitation During Simulated Pediatric Interhospital Transport: Lessons Learned From Implementation of an Institutional Curriculum

“…Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation (CPR) between hospitals is a potentially life-saving endeavor. It provides the opportunity for patients with out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) at a community hospital to access specialized tertiary care resources, such as extracorporeal support 1–3 . We recently conducted a survey that characterized CPR during interhospital transport of children already in cardiac arrest at referring facilities in the United States.…”

“…Specific challenges to achieving and maintaining highquality CPR during pediatric interhospital transport include long transport times, multiple transition points, unpredictable driving conditions, limited availability of resources (personnel, equipment), cramped spaces, difficult communication, and safety of the staff performing manual CPR in a moving vehicle. 3 Some of these variables and their impact on CPR quality have been explored in adult prehospital transport studies. [13][14][15][16][17][18][19][20] Relatively little has been reported about pediatric prehospital resuscitation, with available data suggesting opportunities for professional rescuers to improve CPR quality for children with OHCA.…”

“…It provides the opportunity for patients with out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) at a community hospital to access specialized tertiary care resources, such as extracorporeal support. [1][2][3] We recently conducted a survey that characterized CPR during interhospital transport of children already in cardiac arrest at referring facilities in the United States. We reported that 30% of the 60 respondent pediatric interhospital transport programs performed at least one such transport in the past 5 years, with variable patient outcomes.…”

Consenso de Reanimación Cardiopulmonar Pediátrica del Comité de RCP de la Sociedad Latinoamericana de Cuidados Intensivos Pediátricos (SLACIP). Resumen Ejecutivo

“…Recordar que en pediatría no tenemos evidencia suficiente para una recomendación formal. • Transporte pediátrico y RCP: recomendamos realizar el transporte de un niño mientras se realiza la RCP si se puede garantizar una RCP adecuada durante el transporte y el niño se puede beneficiar de un tratamiento vital en otra institución (por ejemplo ECMO, cirugía, canalización vascular)4 . • Presencia…”