The Hemodynamic Stability of Critically Ill Pediatric Patients with Cardiovascular Diseases during Interhospital Air Ambulance Transport

Background: This study aimed to determine the hemodynamic stability in critically ill pediatric patients with cardiovascular diseases during interhospital transport by air ambulance.

Method: Retrospective analysis of pediatric air ambulance transportation performed by a German air rescue service from January 2015 until December 2018. Data were analyzed from the electronic documentation system and included diagnosis groups, hemodynamic parameters, medication, medical interventions, specialty and training of the air ambulance doctor, technical transport parameters, and incidents during transport.

Results: Of the 1,300 children transported in the 4-year period, 189 (15%) children suffered from cardiovascular diseases. They thus accounted for the third largest group of main diagnoses leading to airborne transport (trauma/accidents 473 [36%], respiratory diseases 264 [20%]). Children with cardiovascular diseases were younger (2.52 vs. 3.45 years; p ≤ 0.0001) and sicker than the others (mean NACA score = 4.5 vs. 3.98; p ≤ 0.0001). In this subgroup, the mean transport distance was also further (114 vs. 102 km; p = 0,103) and more transports were accompanied by an additional pediatrician (25 vs. 14%; p ≤ 0.0001). Although the hemodynamic parameters of patients with cardiovascular diseases were significantly worse than those with other conditions, vital signs remained stable or improved during transport. The analysis of the subgroup revealed some significant, although clinically less important, differences. Hemodynamic parameters before and after transport: saturation (94 vs. 95%; p ≤ 0.0001), respiratory rate (24 vs. 24/min; p = 1.0), systolic blood pressure (104 vs. 104 mm Hg; p = 0.88), heart rate (121 vs. 119/min; p = 0,023), GCS (10.51 vs. 10.52; p = 0,723). Our vital sign score also showed that patients’ health status improved on average during transport (p = 0.001). Only 24 (2%) of the 1,300 patients experienced adverse events during transport. Of these, 13 were patient-related incidents and 11 were equipment failures.

Conclusion: The analysis of this huge and unique cohort of critically ill patients revealed that modern air ambulance intensive transportation service in Germany is safe and effective and does not compromise hemodynamic stability of the critically ill patients. Patients with primary cardiovascular diagnoses were sicker than the other patients, nevertheless this had no effect on the safety of the transportation.

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Artikel online veröffentlicht:
12. Februar 2022