Abstract 16759: Active Management During Transfer of Patients with Suspected Acute Aortic Syndrome (AAS): Observations from an Aortic Network
Background: An acute aortic network requires safe transport of patients by a critical care transport team (CCT) to the referral center. Control of BP is a central therapeutic target. We aimed to analyze safety and effectiveness of active BP management during transfer for this patient population.
Methods: 147 consecutive patients with a pre transfer diagnoses of AAS transferred to our CCU between March 10 and Aug 11 were included. Transfer was carried by our CCT utilizing ground-ambulance (N=28), helicopter (N=105) or fixed-wing jet (N=14). Blood pressure and heart rate was compared at the time of CCT handover to arrival at our CCU. Patients who were in cardiac shock (n=4) on arrival of CCT were excluded.
Results: Baseline characteristics are presented in Table 1. Median transport distance was 40 miles (14 - 80) and mean transfer time was 72 minutes. En-route, CCT administered IV metoprolol, labetalol and nitroprusside and performed placement of arterial lines, peripheral and central venous lines and ET tube (Table 2). Although there was no improvement in heart rate [78.7±18.2 versus 77.1±17.8; p = 0.4] on arrival to the CCU, a significant improvement in Mean arterial pressure (MAP) [98.6 mmHg (SD: 21.8) versus 90.6 mmHg (SD: 18.7)] with an absolute reduction of 8.0 mmHg (95 % CI: 4.2 - 11.8; p<0.001) was noted. There were no episodes of cardiac arrest requiring resuscitation during transit. The transfer mortality rate was 0% (N=0) and the in-hospital mortality rate was 9.8 % (N=14 of 143 patients).
Conclusion: Patients with AAS can be safely transferred for further management. A well trained CCT can effectively maintain and optimize BP control during transit in these patients.
- © 2012 by American Heart Association, Inc.