Top Things to Know: Management of Patients with Cardiac Arrest Requiring Interfacility Transport
Published: September 19, 2024
Prepared by Teresa L. May, DO, MS, MaineHealth Medical Center, and Jonathan Elmer, MD, MS, FAHA, University of Pittsburgh
- Early after resuscitation from cardiac arrest, patients often require interfacility transport (IFT) to receive definitive post-arrest care. These patients are at high risk for decompensation or secondary injury during IFT.
- Optimal methods for building a safe and effective IFT system of care after cardiac arrest are understudied, with many knowledge gaps.
- It is essential that patients who undergo IFT after cardiac arrest be cared for by paramedic-level teams that have expertise in vasopressor titration, mechanical circulatory support, and ventilator management.
- Clear communication among the transferring center, receiving center, and IFT team is crucial to guarantee patient safety. Such communication must encompass discussions on overall clinical stability and potential issues that may arise.
- Integration of IFT infrastructure into regional systems of care is necessary for safe and effective patient care and includes the development of shared protocols for both air medical and ground transport.
- Improving systems for IFT across a wide range of geographic and socioeconomic landscapes will ensure equity and access to high-quality care for all patients.
- It is important to support families and caregivers during the IFT process with clear communication.
- It is vital that post-resuscitation treatments started in the referring emergency department, including active temperature management and hemodynamic optimization, be maintained throughout the IFT process whenever possible.
- Stable airway and vascular access are necessary before transport, as are sufficient skills to manage and obtain an airway and additional vascular access.
- During IFT, it is crucial to avoid hyperoxia, hypoxia, hyperventilation, hypoventilation, and hypotension. In complicated cases or during unanticipated complications, medical oversight is essential to optimizeventilator and hemodynamic management.
Citation
May TL, Bressler EA, Cash RE, Guyette FX, Lin S, Morris NA, Panchal AR, Perrin SM, Vogelsong M, Yeung J, Elmer J; on behalf of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Clinical Cardiology; and Council on Cardiovascular and Stroke Nursing. Management of patients with cardiac arrest requiring interfacility transport: a scientific statement fromthe American Heart Association. Circulation. Published online September 19, 2024. doi: 10.1161/CIR.0000000000001282