Quality of inter-hospital transportation in 431 transport survivor patients suffering from acute respiratory distress syndrome referred to specialist centers
Authors: Blecha Sebastian , Dodoo-Schittko Frank , Brandstetter Susanne , Brandl Magdalena , Dittmar Michael , Graf Bernhard M. , Karagiannidis Christian , Apfelbacher Christian , Bein Thomas ,   For the DACAPO Study Group, Bickenbach Johannes , Beeker Thorben , Schürholz Tobias , Pezechk Jessica , Schloer Jens , Jaschinski Ulrich , Kreuzer Ilse , Kuckein Oliver , Weber-Carstens Steffen , Goldmann Anton , Angermair Stefan , Stoycheva Krista , Brederlau Jörg , Rieckehr Nadja , Schreiber Gabriele , Haennicke Henriette , Bach Friedhelm , Gummelt Immo , Haas Silke , Middeke Catharina , Vedder Ina , Klaproth Marion , Adamzik Michael , Karlik Jan , Martini Stefan , Robitzky Luisa , Putensen Christian , Muders Thomas , Lohmer Ute , Dembinski Rolf , Schäffner Petra , Wulff-Werner Petra , Landsiedel-Mechenbier Elke , Nickoleit-Bitzenberger Daniela , Silber Ann-Kathrin , Ragaller Maximilian , de Abreu Marcello Gama , Ulbricht Alin , Reisbach Linda , Zacharowski Kai , Meybohm Patrick , Pense Karin , Schwarzmann Gerhard , Reske Johannes , Hötzel Alexander , Kalbhenn Johannes , Metz Christoph , Haschka Stefan , Rauch Stefan , Quintel Michael , Harnisch Lars-Olav , Baumann Sophie , Kernchen Andrea , Friesecke Sigrun , Maletzki Sebastian , Kluge Stefan , Boenisch Olaf , Frings Daniel , Füllekrug Birgit , Jahn Nils , Kampe Knut , Ringeis Grit , Singer Brigitte , Wüstenberg Robin , Ahrens Jörg , Ruschulte Heiner , Gerdes Andre , Groß Matthias , Wiesner Olaf , Bayat-Graw Aleksandra , Brenner Thorsten , Schmitt Felix , Lipinski Anna , Henzler Dietrich , Eickmeyer Klaas , Krebs Juliane , Rodenberg Iris , Groesdonk Heinrich , Meiers Kathrin , Salm Karen , Volk Thomas , Fischer Stefan , Redwan Basam , Schmölz Martin , Schumann-Stoiber Kathrin , Eberl Simone , Lenz Gunther , von Wernitz-Keibel Thomas , Zackel Monika , Bloos Frank , Bloos Petra , Braune Anke , Haucke Anja , Noack Almut , Kolanos Steffi , Kuhnsch Heike , Knuhr-Kohlberg Karina , Gehling Markus , Haller Mathias , Sturm Anne , Rossenbach Jannik , Schädler Dirk , D’Aria Stefanie , Karagiannidis Christian , Straßmann Stephan , Windisch Wolfram , Annecke Thorsten , Herff Holger , Schütz Michael , Bercker Sven , Reising Hannah , Dathe Mandy , Schlegel Christian , Lichy Katrin , Zink Wolfgang , Kötteritzsch Jana , Bodenstein Marc , Mauff Susanne , Straub Peter , Strang Christof , Prätsch Florian , Hachenberg Thomas , Kirschning Thomas , Friedrich Thomas , Mangold Dennis , Rolfes Caroline , Koch Tilo , Haake Hendrik , Offermanns Katrin , Friederich Patrick , Bingold Florian , Irlbeck Michael , Zwissler Bernhard , Kaufmann Ines , Bogdanski Ralph , Kapfer Barbara , Heim Markus , Edenharter Günther , Ellger Björn , Bause Daniela , Gerresheim Götz , Muschner Dorothea , Christ Michael , Geise Arnim , Beiderlinden Martin , Heuter Thorsten , Wipfel Alexander , Kargl Werner , Harth Marion , Englmeier Christian , Bein Thomas , Blecha Sebastian , Thomann-Hackner Kathrin , Zeder Marius , Stephan Markus , Glaser Martin , Häberle Helene , Bracht Hendrik , Heer Christian , Mast Theresa , Kredel Markus , Müllenbach Ralf 
Published: January 2018

Abstract
Background
The acute respiratory distress syndrome (ARDS) is a life-threatening condition. In special situations, these critically ill patients must be transferred to specialized centers for escalating treatment. The aim of this study was to evaluate the quality of inter-hospital transport (IHT) of ARDS patients.

Methods
We evaluated medical and organizational aspects of structural and procedural quality relating to IHT of patients with ARDS in a prospective nationwide ARDS study. The qualification of emergency staff, the organizational aspects and the occurrence of critical events during transport were analyzed.

Results
Out of 1234 ARDS patients, 431 (34.9%) were transported, and 52 of these (12.1%) treated with extracorporeal membrane oxygenation. 63.1% of transferred patients were male, median age was 54 years, and 26.8% of patients were obese. All patients were mechanically ventilated during IHT. Pressure-controlled ventilation was the preferred mode (92.1%). Median duration to organize the IHT was 165 min. Median distance for IHT was 58 km, and median duration of IHT 60 min. Forty-two patient-related and 8 technology-related critical events (11.6%, 50 of 431 patients) were observed. When a critical event occurred, the PaO2/FiO2 ratio before transport was significant lower (68 vs. 80 mmHg, p = 0.017). 69.8% of physicians and 86.7% of paramedics confirmed all transfer qualifications according to requirements of the German faculty guidelines (DIVI).

Conclusions
The transport of critically ill patients is associated with potential risks. In our study the rate of patient- and technology-related critical events was relatively low. A severe ARDS with a PaO2/FiO2 ratio < 70 mmHg seems to be a risk factor for the appearance of critical events during IHT. The majority of transport staff was well qualified. Time span for organization of IHT was relatively short. ECMO is an option to transport patients with a severe ARDS safely to specialized centers.
Trial registration NCT02637011 (ClinicalTrials.gov, Registered 15 December 2015, retrospectively registered)