Ruben D Troncoso1, Eric M Garfinkel2, David Leon2, Sandra M Lopez2, Andrew Lin2, Dennis Jones3, Shawn Trautman3, Matthew J Levy4, Asa M Margolis4. 1. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Lifeline Critical Care Transportation Program, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: rtronco1@jhmi.edu. 2. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Johns Hopkins Lifeline Critical Care Transportation Program, Johns Hopkins University School of Medicine, Baltimore, MD. 4. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Lifeline Critical Care Transportation Program, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
OBJECTIVE: There are limited data regarding the typical characteristics of coronavirus disease 2019 (COVID-19) patients requiring interfacility transport or the clinical capabilities of the out-of-hospital transport clinicians required to provide safe transport. The objective of this study is to provide epidemiologic data and highlight the clinical skill set and decision making needed to transport critically ill COVID-19 patients. METHODS: A retrospective chart review of persons under investigation for COVID-19 transported during the first 6 months of the pandemic by Johns Hopkins Lifeline was performed. Patients who required interfacility transport and tested positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction assay were included in the analysis. RESULTS: Sixty-eight patients (25.4%) required vasopressor support, 35 patients (13.1%) were pharmacologically paralyzed, 15 (5.60%) were prone, and 1 (0.75%) received an inhaled pulmonary vasodilator. At least 1 ventilator setting change occurred for 59 patients (22.0%), and ventilation mode was changed for 11 patients (4.10%) during transport. CONCLUSION: The safe transport of critically ill patients with COVID-19 requires experience with vasopressors, paralytic medications, inhaled vasodilators, prone positioning, and ventilator management. The frequency of initiated critical interventions and ventilator adjustments underscores the tenuous nature of these patients and highlights the importance of transport clinician reassessment, critical thinking, and decision making.
OBJECTIVE: There are limited data regarding the typical characteristics of coronavirus disease 2019 (COVID-19) patients requiring interfacility transport or the clinical capabilities of the out-of-hospital transport clinicians required to provide safe transport. The objective of this study is to provide epidemiologic data and highlight the clinical skill set and decision making needed to transport critically illCOVID-19patients. METHODS: A retrospective chart review of persons under investigation for COVID-19 transported during the first 6 months of the pandemic by Johns Hopkins Lifeline was performed. Patients who required interfacility transport and tested positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction assay were included in the analysis. RESULTS: Sixty-eight patients (25.4%) required vasopressor support, 35 patients (13.1%) were pharmacologically paralyzed, 15 (5.60%) were prone, and 1 (0.75%) received an inhaled pulmonary vasodilator. At least 1 ventilator setting change occurred for 59 patients (22.0%), and ventilation mode was changed for 11 patients (4.10%) during transport. CONCLUSION: The safe transport of critically illpatients with COVID-19 requires experience with vasopressors, paralytic medications, inhaled vasodilators, prone positioning, and ventilator management. The frequency of initiated critical interventions and ventilator adjustments underscores the tenuous nature of these patients and highlights the importance of transport clinician reassessment, critical thinking, and decision making.
Authors: Connor J Brown; Nicolas Rubel; Jason Lai; Christen Ward; Justin McLean; Martin Wheelock; Michael Steuerwald; Andrew Cathers Journal: Air Med J Date: 2022-03-10
Authors: Maj William T Davis; Maj Patrick C Ng; Julie E Cutright; Shelia C Savell; Allyson A Arana; Brooks McCarvel; Lt Col Joseph K Maddry Journal: Air Med J Date: 2021-09-27