Achieving Optimal Therapeutic Hypothermia on Transport

Area of Science:

• Neonatal medicine
• Pediatric critical care
• Transport medicine

Background:

• Therapeutic hypothermia (TH) improves outcomes for neonates with hypoxic ischemic encephalopathy (HIE).
• Transporting these infants to specialized centers presents challenges in maintaining target temperatures.
• Limited availability of flight-approved servo-controlled cooling devices complicates active cooling during air transport.

Purpose of the Study:

• To introduce a clinical bundle for safe, active, or passive cooling during neonatal transport.
• To achieve targeted and accurate temperature control for neonates requiring TH.
• To provide a protocol applicable to both air and ground transport.

Main Methods:

• A clinical bundle was implemented for neonates meeting TH criteria.
• Referring centers received instructions for passive cooling initiation.
• Transport teams followed strict protocols to reach and maintain target temperatures (33°C–35°C).

Main Results:

• Twenty-two neonates were transported using the care bundle between June 2010 and January 2014.
• Eight neonates received active cooling, and 14 received passive cooling.
• Average temperatures upon arrival at the receiving facility were within the target range (33.5°C).

Conclusions:

• The developed care bundle enables safe transport of neonates for TH initiation.
• This approach ensures neonates arrive at treatment centers within the therapeutic temperature range without extreme fluctuations.
• Future research should evaluate the bundle's effectiveness in larger populations and with diverse transport teams.