Safe long-distance interhospital ground transfer of critically ill patients with acute severe unstable respiratory and circulatory failure

OBJECTIVE: To assess the safety of long-distance ground interhospital transport of critically ill patients with the most severe unstable respiratory failure after establishment of a dedicated transport system. DESIGN AND SETTING: Cohort study, retrospective chart review in 13 hospitals and intensive care units (ICU) in Finland, and a tertiary referral center and ICU of a university hospital. PATIENTS: 66 consecutive critically ill patients who were transferred to our ICU from 13 different ICUs in Finland because of severe, progressive respiratory failure, 52 (79%) with acute respiratory distress syndrome. MEASUREMENTS AND RESULTS: Major complications during transfer and patients' oxygenation. The median transfer distance was 161 km (range 120-460 km). Drugs for cardiovascular support were infused in 59 patients (89%) during transfer. Fourteen patients (21%) were transferred in prone position because of life-threatening hypoxemia. The ratio of arterial blood PaO(2) and the fraction of oxygen in the ventilator was 8.5+/-2.7 kPa (64+/-20 mmHg) before transfer and 9.7+/-3.6 kPa (73+/-27 mmHg) after transfer. There were no major complications during the transfer. ICU mortality was 30%. CONCLUSIONS: Long-distance interhospital ground transfer of even critically ill patients with severe unstable respiratory and circulatory failure is safe if a dedicated transport team and a specially equipped transport vehicle are used.