Interfacility Open Chest Cardiothoracic Patients: Treatment and Transport Considerations

Open chest cardiothoracic transports are becoming more common; however, they require more planning and critical thinking before initiating transport. These patients require complex treatment modalities and extensive training of the crews transporting them to include, but not limited to, the ability to internally defibrillate using paddles, effective open cardiac massage, and the availability of blood products in the event of hemorrhagic shock. A case involving a 55-year-old white man status post cardiac arrest with an unknown downtime resulted in transport to the nearest facility. Return of spontaneous circulation was achieved after several rounds of advanced cardiac life support, and the patient underwent cardiac catheterization during which multivessel disease was discovered. He had an intra-aortic balloon pump placed, and transport was requested to a facility capable of placing extracorporeal membrane oxygenation. Upon arrival of the flight crew, the cardiothoracic surgeon was exploring the patient's chest bedside for uncontrolled hemorrhage and possible cardiac tamponade. The patient's chest was left open, and he was hemodynamically unstable. The considerations for transport included how the crew would provide defibrillation and cardiopulmonary resuscitation in the event the patient were to arrest. The crew also needed blood products for ongoing hemorrhage. This article discusses considerations for the treatment and transport of these patients.