Transfer of intra-aortic balloon pump-dependent patients by paramedics

This prospective case series describes the experience of a specially trained critical care paramedic transfer program that transports intra-aortic balloon pump (IABP)-dependent patients to definitive cardiac surgical care without additional medical escorts. Paramedics complete a standard ambulance patient care report and a quality management report for each IABP-dependent patient transported. All patient care reports were routinely screened for calls involving IABP-dependent patients to ensure all calls were captured. Demographic, patient care, adverse event, and transfer-related data were collected prospectively. The program manager and medical director independently examined all reports for quality of care and occurrence of adverse events. Missing data were obtained from paramedic crews and referring facilities. The IABP program transported 29 patients during its first 24 months. The mean patient age was 63.4 +/- 10.4 years, and the majority were male (25 of 29; 86.2%). The most common indications for IABP insertion were bridge to definitive surgical care (17; 58.6%) and cardiogenic shock (13; 44.8%). The mean out-of-hospital time was 39.9 +/- 26.1 minutes. There were 22 complications in 11 patients. Paramedics successfully managed all complications. There was no persistent life-threatening patient-related complication or IABP-related malfunction, and no patient died during transport. This case series demonstrates that specially trained critical care paramedics can safely IABP-dependent patients to definitive cardiac surgical care without additional medical escorts.