Quality of inter-hospital transportation in 431 transport survivor patients suffering from acute respiratory distress syndrome referred to specialist centers

Sebastian Blecha, Frank Dodoo-Schittko, Susanne Brandstetter, Magdalena Brandl, Michael Dittmar, Bernhard M Graf, Christian Karagiannidis, Christian Apfelbacher, Thomas Bein, DACAPO Study Group, Johannes Bickenbach, Thorben Beeker, Tobias Schürholz, Jessica Pezechk, Jens Schloer, Ulrich Jaschinski, Ilse Kreuzer, Oliver Kuckein, Steffen Weber-Carstens, Anton Goldmann, Stefan Angermair, Krista Stoycheva, Jörg Brederlau, Nadja Rieckehr, Gabriele Schreiber, Henriette Haennicke, Friedhelm Bach, Immo Gummelt, Silke Haas, Catharina Middeke, Ina Vedder, Marion Klaproth, Michael Adamzik, Jan Karlik, Stefan Martini, Luisa Robitzky, Christian Putensen, Thomas Muders, Ute Lohmer, Rolf Dembinski, Petra Schäffner, Petra Wulff-Werner, Elke Landsiedel-Mechenbier, Daniela Nickoleit-Bitzenberger, Ann-Kathrin Silber, Maximilian Ragaller, Marcello Gama de Abreu, Alin Ulbricht, Linda Reisbach, Kai Zacharowski, Patrick Meybohm, Karin Pense, Gerhard Schwarzmann, Johannes Reske, Alexander Hötzel, Johannes Kalbhenn, Christoph Metz, Stefan Haschka, Stefan Rauch, Michael Quintel, Lars-Olav Harnisch, Sophie Baumann, Andrea Kernchen, Sigrun Friesecke, Sebastian Maletzki, Stefan Kluge, Olaf Boenisch, Daniel Frings, Birgit Füllekrug, Nils Jahn, Knut Kampe, Grit Ringeis, Brigitte Singer, Robin Wüstenberg, Jörg Ahrens, Heiner Ruschulte, Andre Gerdes, Matthias Groß, Olaf Wiesner, Aleksandra Bayat-Graw, Thorsten Brenner, Felix Schmitt, Anna Lipinski, Dietrich Henzler, Klaas Eickmeyer, Juliane Krebs, Iris Rodenberg, Heinrich Groesdonk, Kathrin Meiers, Karen Salm, Thomas Volk, Stefan Fischer, Basam Redwan, Martin Schmölz, Kathrin Schumann-Stoiber, Simone Eberl, Gunther Lenz, Thomas von Wernitz-Keibel, Monika Zackel, Frank Bloos, Petra Bloos, Anke Braune, Anja Haucke, Almut Noack, Steffi Kolanos, Heike Kuhnsch, Karina Knuhr-Kohlberg, Markus Gehling, Mathias Haller, Anne Sturm, Jannik Rossenbach, Dirk Schädler, Stefanie D'Aria, Christian Karagiannidis, Stephan Straßmann, Wolfram Windisch, Thorsten Annecke, Holger Herff, Michael Schütz, Sven Bercker, Hannah Reising, Mandy Dathe, Christian Schlegel, Katrin Lichy, Wolfgang Zink, Jana Kötteritzsch, Marc Bodenstein, Susanne Mauff, Peter Straub, Christof Strang, Florian Prätsch, Thomas Hachenberg, Thomas Kirschning, Thomas Friedrich, Dennis Mangold, Caroline Rolfes, Tilo Koch, Hendrik Haake, Katrin Offermanns, Patrick Friederich, Florian Bingold, Michael Irlbeck, Bernhard Zwissler, Ines Kaufmann, Ralph Bogdanski, Barbara Kapfer, Markus Heim, Günther Edenharter, Björn Ellger, Daniela Bause, Götz Gerresheim, Dorothea Muschner, Michael Christ, Arnim Geise, Martin Beiderlinden, Thorsten Heuter, Alexander Wipfel, Werner Kargl, Marion Harth, Christian Englmeier, Thomas Bein, Sebastian Blecha, Kathrin Thomann-Hackner, Marius Zeder, Markus Stephan, Martin Glaser, Helene Häberle, Hendrik Bracht, Christian Heer, Theresa Mast, Markus Kredel, Ralf Müllenbach, Sebastian Blecha, Frank Dodoo-Schittko, Susanne Brandstetter, Magdalena Brandl, Michael Dittmar, Bernhard M Graf, Christian Karagiannidis, Christian Apfelbacher, Thomas Bein, DACAPO Study Group, Johannes Bickenbach, Thorben Beeker, Tobias Schürholz, Jessica Pezechk, Jens Schloer, Ulrich Jaschinski, Ilse Kreuzer, Oliver Kuckein, Steffen Weber-Carstens, Anton Goldmann, Stefan Angermair, Krista Stoycheva, Jörg Brederlau, Nadja Rieckehr, Gabriele Schreiber, Henriette Haennicke, Friedhelm Bach, Immo Gummelt, Silke Haas, Catharina Middeke, Ina Vedder, Marion Klaproth, Michael Adamzik, Jan Karlik, Stefan Martini, Luisa Robitzky, Christian Putensen, Thomas Muders, Ute Lohmer, Rolf Dembinski, Petra Schäffner, Petra Wulff-Werner, Elke Landsiedel-Mechenbier, Daniela Nickoleit-Bitzenberger, Ann-Kathrin Silber, Maximilian Ragaller, Marcello Gama de Abreu, Alin Ulbricht, Linda Reisbach, Kai Zacharowski, Patrick Meybohm, Karin Pense, Gerhard Schwarzmann, Johannes Reske, Alexander Hötzel, Johannes Kalbhenn, Christoph Metz, Stefan Haschka, Stefan Rauch, Michael Quintel, Lars-Olav Harnisch, Sophie Baumann, Andrea Kernchen, Sigrun Friesecke, Sebastian Maletzki, Stefan Kluge, Olaf Boenisch, Daniel Frings, Birgit Füllekrug, Nils Jahn, Knut Kampe, Grit Ringeis, Brigitte Singer, Robin Wüstenberg, Jörg Ahrens, Heiner Ruschulte, Andre Gerdes, Matthias Groß, Olaf Wiesner, Aleksandra Bayat-Graw, Thorsten Brenner, Felix Schmitt, Anna Lipinski, Dietrich Henzler, Klaas Eickmeyer, Juliane Krebs, Iris Rodenberg, Heinrich Groesdonk, Kathrin Meiers, Karen Salm, Thomas Volk, Stefan Fischer, Basam Redwan, Martin Schmölz, Kathrin Schumann-Stoiber, Simone Eberl, Gunther Lenz, Thomas von Wernitz-Keibel, Monika Zackel, Frank Bloos, Petra Bloos, Anke Braune, Anja Haucke, Almut Noack, Steffi Kolanos, Heike Kuhnsch, Karina Knuhr-Kohlberg, Markus Gehling, Mathias Haller, Anne Sturm, Jannik Rossenbach, Dirk Schädler, Stefanie D'Aria, Christian Karagiannidis, Stephan Straßmann, Wolfram Windisch, Thorsten Annecke, Holger Herff, Michael Schütz, Sven Bercker, Hannah Reising, Mandy Dathe, Christian Schlegel, Katrin Lichy, Wolfgang Zink, Jana Kötteritzsch, Marc Bodenstein, Susanne Mauff, Peter Straub, Christof Strang, Florian Prätsch, Thomas Hachenberg, Thomas Kirschning, Thomas Friedrich, Dennis Mangold, Caroline Rolfes, Tilo Koch, Hendrik Haake, Katrin Offermanns, Patrick Friederich, Florian Bingold, Michael Irlbeck, Bernhard Zwissler, Ines Kaufmann, Ralph Bogdanski, Barbara Kapfer, Markus Heim, Günther Edenharter, Björn Ellger, Daniela Bause, Götz Gerresheim, Dorothea Muschner, Michael Christ, Arnim Geise, Martin Beiderlinden, Thorsten Heuter, Alexander Wipfel, Werner Kargl, Marion Harth, Christian Englmeier, Thomas Bein, Sebastian Blecha, Kathrin Thomann-Hackner, Marius Zeder, Markus Stephan, Martin Glaser, Helene Häberle, Hendrik Bracht, Christian Heer, Theresa Mast, Markus Kredel, Ralf Müllenbach

Abstract

Background: The acute respiratory distress syndrome (ARDS) is a life-threatening condition. In special situations, these critically ill patients must be transferred to specialized centers for escalating treatment. The aim of this study was to evaluate the quality of inter-hospital transport (IHT) of ARDS patients.

Methods: We evaluated medical and organizational aspects of structural and procedural quality relating to IHT of patients with ARDS in a prospective nationwide ARDS study. The qualification of emergency staff, the organizational aspects and the occurrence of critical events during transport were analyzed.

Results: Out of 1234 ARDS patients, 431 (34.9%) were transported, and 52 of these (12.1%) treated with extracorporeal membrane oxygenation. 63.1% of transferred patients were male, median age was 54 years, and 26.8% of patients were obese. All patients were mechanically ventilated during IHT. Pressure-controlled ventilation was the preferred mode (92.1%). Median duration to organize the IHT was 165 min. Median distance for IHT was 58 km, and median duration of IHT 60 min. Forty-two patient-related and 8 technology-related critical events (11.6%, 50 of 431 patients) were observed. When a critical event occurred, the PaO2/FiO2 ratio before transport was significant lower (68 vs. 80 mmHg, p = 0.017). 69.8% of physicians and 86.7% of paramedics confirmed all transfer qualifications according to requirements of the German faculty guidelines (DIVI).

Conclusions: The transport of critically ill patients is associated with potential risks. In our study the rate of patient- and technology-related critical events was relatively low. A severe ARDS with a PaO2/FiO2 ratio < 70 mmHg seems to be a risk factor for the appearance of critical events during IHT. The majority of transport staff was well qualified. Time span for organization of IHT was relatively short. ECMO is an option to transport patients with a severe ARDS safely to specialized centers. Trial registration NCT02637011 (ClinicalTrials.gov, Registered 15 December 2015, retrospectively registered).

Keywords: ARDS; Inter-hospital transfer; Quality of care.

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