Incidence of re-arrest and critical events during prolonged transport of post-cardiac arrest patients☆☆☆★
Received 19 November 2009; received in revised form 30 March 2010; accepted 13 April 2010. published online 20 May 2010.
Abstract
Aim
To determine the feasibility of transporting post-cardiac arrest patients to tertiary-care facilities, the rate of re-arrest, and the rate of critical events during critical care transport team (CCTT) care.
Methods
Retrospective chart review of cardiac arrest patients transported via CCTT between 1/1/2001 and 5/31/2009. Demographic information, re-arrest, and critical events during transport were abstracted. We defined critical events as hypotension (systolic blood pressure<90mmHg), hypoxia (oxygen saturation<90%), or both hypotension and hypoxia at any time during CCTT care. Comparisons were performed using Chi-squared test and a Cox proportional hazards model was employed to determine predictors of events.
Results
Of the 248 patients studied, the majority was male (61%), presented in ventricular fibrillation or ventricular tachycardia (VF/VT, 50%), and comatose (80%). Re-arrest was uncommon (N=15; 6%). Critical events affected 58 patients (23%) during transport. Median transport time was 63min (IQR 51, 81) in both those who experienced a critical event and those who did not. Vasopressor use was associated with any decompensation during CCTT (Hazard Ratio 1.81; 95%CI 1.29, 2.54). Three patients (20%) suffering re-arrest survived to hospital discharge. Survival (Chi square 11.77; p<0.01) and good neurologic outcome (Chi square 5.93; p=0.01) were higher in patients who did not suffer any event during transport.
Conclusions
Transport of resuscitated cardiac arrest patients to a tertiary-care facility via CCTT is feasible, and the duration of transport is not associated with re-arrest during transport. Repeat cardiac arrest occurs infrequently, while critical events are more common. Outcomes are worse in those experiencing an event.
aUniversity of Pittsburgh, Affiliated Residency in Emergency Medicine, United States
bUniversity of Pittsburgh, Department of Emergency Medicine, United States
Corresponding author at: University of Pittsburgh, Department of Emergency Medicine, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15261, United States. Tel.: +1 412 647 9489; fax: +1 412 647 6999.
ABSTRACT