Cardiac arrest in critical care transport: A case-control study

Area of Science:

• Emergency Medicine
• Critical Care
• Transport Medicine

Background:

• Clinical deterioration and decompensation are known risks during patient movement and transport, particularly for critically ill individuals.
• The acuity of a patient directly correlates with the risk and potential consequences of decompensation during transport.

Purpose of the Study:

• To identify factors associated with cardiac arrest in patients undergoing critical care transport (CCT).
• To analyze the outcomes of patients experiencing cardiac arrest during CCT.

Main Methods:

• A descriptive and case-control study was conducted on patients experiencing cardiac arrest after CCT team arrival between October 2020 and September 2022.
• Inclusion criteria focused on patients with arrest post-CCT team arrival; exclusions included scene transports, pediatric patients, and those not arresting en route or not transported.

Main Results:

• Over two years, 87 patients (0.7%) experienced cardiac arrest post-CCT arrival, with common transport indications including severe trauma, respiratory arrest, and aortic emergencies.
• Case-control analysis revealed associations between cardiac arrest and mode of transport (OR 2.66), number of vasopressors (ORs ranging from 3.46 to 16.0), and initial mean arterial pressure (MAP) and systolic blood pressure (SBP) (OR 0.98 for both).
• Of 32 patients who arrested in transport, only 15 (46.9%) achieved return of spontaneous circulation (ROSC).

Conclusions:

• Mode of transport, vasopressor use, and initial MAP and SBP are significant variables associated with cardiac arrest during CCT.
• Despite the uncommon occurrence of cardiac arrest, the rate of ROSC remains low at 46.9%.
• Further research is needed to establish risk thresholds for patient arrest during transport.