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

Numerous prior works have demonstrated the risk of clinical deterioration with movement and transport, and the higher the patient's acuity, the higher the risk and consequence of decompensation.

We performed a descriptive study of patients with a cardiac arrest during critical care transport (CCT) October 2020 through September 2022. Inclusion criteria included all patients with arrest after the arrival of the CCT team. To analyze factors associated with arrest, we performed a case-control study. Exclusion criteria included scene transports, pediatric patients, patients who did not arrest en route, and patients not transported.

Over two years, 87 patients (0.7 %) had a cardiac arrest after arrival of the CCT team. The most common indications for transport were severe trauma, respiratory arrest, and aortic emergencies, and patients were commonly ED to ED transfers. In the case-control assessment, four variables were associated with arrest: mode of transport, OR 2.66 (95 % CI 1.05-6.75), number of vasopressors [1, OR 3.46 (95 % CI 1.05-11.39), 2, OR 6.67 (95 % CI 1.97-22.55), 3, OR 16.0, (95 % CI 3.77-68.0)], and initial MAP and SBP [both OR 0.98 (95 % CI 0.97-0.99)]. Of the 32 patients who arrested in transport, only 15 (46.9 %) had return of spontaneous circulation (ROSC).

In a case-control assessment, four variables were associated with arrest in CCT: mode of transport, the number of vasopressors, the initial MAP, and the initial SBP. While cardiac arrest was uncommon, the rate of ROSC was only 46.9 %. Future work should build upon this work to determine thresholds for which patients are at the highest risk for arrest in transport.