Critical care transport of prone position ARDS patient by a RN and paramedic team.

1. Transport of a Prone Position
Acute Respiratory Distress
Syndrome Patient
David Hersey BA, BScN
Life Flight Nova Scotia

2. • Prehospital transport of prone position acute respiratory distress syndrome
(ARDS) is not unprecedented.
• One case series (n=7) and two case reports described the transport of prone
ARDS patients by ambulance, airplane and helicopter.
• Life Flight Nova Scotia identified a patient need and developed a prone position
transport protocol.
Summary
Transport of a Prone Position Acute Respiratory Distress Syndrome Patient

3. • Critical Care services are regionalized with one large academic teaching hospital (Queen
Elizabeth II Health Sciences Centre, Halifax, Nova Scotia ).
• Advanced treatments (ECMO & CRRT) for severe ARDS patients are only available at the QEII.
• The need to transport severe ARDS patients from community / regional hospitals to the QEII
will correspondingly increase.
• One health authority (Nova Scotia Health Authority), one ambulance service (Emergency Health
Services Nova Scotia) and a small experienced critical care team simplified the development of
a prone transport protocol.
Patient Population Need
Transport of a Prone Position Acute Respiratory Distress Syndrome Patient

4. • Early prone positioning is beneficial with
severe ARDS.
• Two trends identified:
• Sending hospitals: Prone positioning
was delayed due to lack staff comfort
• Sending Hospitals: Interruption of
prone positioning for transport.
• Literature Review (case series / case
reports) demonstrated that prone patient
transport is feasible.
• Developed a protocol and training plan
• Reviewed and approved by Dr. T. Witter
• Crew Training: Online learning package
plus in situ simulations
Provide additional information
or references, or add an image
or figure here
Background

5. • Patient meets the ARDS criteria
• Consultation with Medical Control Physicians
and the receiving Intensivist (QEII)
• Follow the checklist (supine-to-prone) (prone-
to-prone)
• Place prone patient on transport stretcher.
• Prone patient can be transported by air
(helicopter or plane) or ambulance.
• Estimate 1-3 transports per year based on
historical trends.
Protocol
Transport of a Prone Position Acute Respiratory Distress Syndrome Patient

6. Checklists

7. Checklists

8. •Six patients have meet the criteria over the past 2 years.
•Two prone patients transported by ambulance (supine-to-prone protocol).
•Both patient demonstrated improved oxygenation and ventilation
(consent only obtained for patient #2).
•Two patients not placed in the prone position due to BMI (transported
supine).
•One decline for no arterial line in position (transported supine)
•One patient died before the critical care team’s arrived.
Results
PATIENT TWO: FiO2 pH PaCO2 PaO2 PaO2 / FiO2 Ratio
#1 Pre Prone Position 0.8 7.11 90.8 90.1 112.5
#2 Post Pone Position (30 minutes) 0.8 7.17 78.4 79.9 98.75
#3Post Transfer of Care (1st) (13 minutes) 0.8 7.29 59 136 170
#4Post Transfer of Care (2nd
) (50 minutes) 0.8 7.35 52 96 122.5
Transport of a Prone Position Acute Respiratory Distress Syndrome Patient

9. • Critical care transport
of prone ARDS patients
is a feasible and cost
effective intervention
that will prevent
treatment delays and
interruptions.
Conclusion
Transport of a Prone Position Acute Respiratory Distress Syndrome Patient

10. • Retrospective case review once our number transports increase.
• Work with other transport programs (paramedic/paramedic).
• Can our experience be generalized to other agencies? Larger
teams?
Next steps / Future work
Transport of a Prone Position Acute Respiratory Distress Syndrome Patient

11. Questions?